MD/PhD Playbook: A First-Gen Student’s Perspective of MD/PhD

Jake Khoussine
16 min readMar 6, 2023

Everyone wants a playbook for success. The path to MD/PhD is complicated, and each person starts their journey from a different point. This makes a prescriptive approach hard to convey. You need to know your strengths and weaknesses and be ready to leverage them at the right place and time for success. I can tell you what to do and how to do it, but sometimes you need to take the knocks in life to internalize the advice.

Here, I will provide you with a step-by-step blueprint to become a competitive applicant and start accruing the necessary experiences to get into an MD/PhD program.

I want this playbook to be timeless. It will focus on a motivated student who starts college with premed aspirations, but who also realizes that they want more from their career than being a physician. This is for those who desire greater depth and who dislike being placed into a box. These students recognize the problems in medicine and want to devise creative solutions. In other words, me, and maybe you, too.

I think all premed students should prepare for medical school as if they want to apply for MD/PhD. Scientific research is the best way to stand out in medical school admissions. Everyone gets clinical experiences, but far fewer conduct rigorous lab research. You need to gain patient care experience and demonstrate commitment to serving others as a premedical student, however, the admissions committee doesn’t expect you to develop clinical skills as an undergraduate. Believe me, I was an emergency department technician in college. I did phlebotomy, placed catheters, performed CPR, transported patients, and more. From all those activities, what mattered the most in applying to medical school successfully was the experience I gained from communicating with diverse patients, practicing empathy in vulnerable situations, and understanding the challenges inherent to a person’s illness experience. All that practical stuff makes for good stories and has shock value, but it’s not what will distinguish you in admissions for top MD/PhD programs.

Research, on the other hand, teaches you skills that are not taught in medical school, which make them far more valuable from a diversity perspective. Students who have not just learned the science, but also have practiced science to understand the fundamentals underpinning clinical medicine distinguish themselves. Further, the expression of novel research findings allows students to share the contributions they’ve made toward advancing biomedical science. This MD/PhD playbook is an essential resource for students that want to become physician-scientists, yet its utility should not be overlooked by students who aim to be competitive for medical school, as well.

As a first-generation student in my 5th year of MD/PhD training, I have the benefit of retrospect to recognize what I should have done better from the start. From interacting with the admissions committees over the years, I know what they look for in competitive applicants. Through advising students to get into MD and MD/PhD programs, I’m confident in this recipe for success. All that’s left for you to do is execute. Let’s start from the beginning.

Freshman year — build your foundation and foster relationships

College is expensive. Enjoy college but do it with focus. Your major doesn’t matter; all that matters is that you complete the prerequisites for medical school. Take classes that interest you and develop good study hygiene from the beginning. A semester lapse in judgment can be recovered from in terms of GPA, though digging yourself out of a hole is unnecessarily stressful.

Spend the first semester getting a strong foundation. What areas of science excite you? Go to professors’ office hours who you want to connect with and build relationships. Ask questions about research and talk with more senior students who are already in labs.

You will stand out if you do the things that other students are afraid to do. That means sending cold emails and striking up conversations with strangers who are doing the things you aspire to achieve. This is essential for finding mentorship.

It doesn’t matter what area of research you start with as much as it matters who you pick as a mentor. Take time to explore your options. By starting early, you have the flexibility to change labs and follow your curiosity. While quality beats quantity, the more time you spend pursuing research experiences, the better you will become at identifying where your interests align, and passions emerge.

Start the process of finding clinical experiences through shadowing. This is your introduction to medicine and is low stakes. I emailed physicians in the pediatric emergency department, explained I was a motivated premed student, and asked to shadow them in the hospital. You might get rejected from multiple physicians because they’re too busy, and you’re a liability. There will be one that accepts you warmly who remembers what it’s like to start out. The emergency department is a nice option for shadowing because the physicians work night shifts, allowing you to spend a couple evenings each week from 7–11pm learning medicine in a fast-paced environment. The more you see and do, the faster you will get up to speed. As you form a relationship with the physician, you can tap into their medical network. Who else do they know that could support you and where might you find a clinical role with more direct patient care opportunities? These relationships are essential to finding serendipity and opportunity.

By the end of freshman year, you should be building relationships with clinical and research mentors. These could be long-lasting relationships or entry points. Let the vibe help you determine your direction. The most important thing is that you get started. The summer of freshman year is, in my opinion, free for exploration. I took a class through my chemistry department to study organic chemistry and wine- and coffee-making in Italy. As a student who at first neglected the value of research, it was through recognizing how organic chemistry underpins life — I love coffee and wine — that motivated me to take a closer look at scientific research. If you’ve never left the US, I encourage you to expand your worldview during this time. However, if it’s too expensive to go abroad, there are abundant opportunities to expand your worldview at home. Seek opportunities to interact with people outside your bubble — whatever it may be. These experiences compound and will be crucial when it’s time to write your admission’s essays.

Although I recommend doing summer research after sophomore year, you can also do it after freshman year. Summer research after freshman year provides you more time to develop your longitudinal commitment to research. The decision of when to begin summer research depends on your interests; there’s no one correct answer. More research experience will make you more competitive for MD/PhD. I encourage you to not neglect life experiences that you desire to fit in more time for lab early in college.

Instead, I advise prioritizing life experiences early and considering post-bacc research later once your foundation is solid and interests have developed, if necessary. I will explain more on the topic of post-bacc research later.

Sophomore year — it’s time to hustle

After you’ve established a foundation and developed leads to explore your interests, it’s time to deepen your knowledge. You’ll most likely be taking the more difficult prerequisites of organic chemistry, physics, and molecular biology in sophomore year, and it’s going to require dedication for you to get the grades. By this time, you should have decided whose lab you will join. Early in sophomore year, plan with your PI to read the most important literature both from the lab and the research field. It’s critical that you learn how to read scientific papers and practice discussing ideas with your mentor. It will be like learning a new language.

Start shadowing students in the lab to see the experiments they are conducting and how it works in theory and practice. Ask questions, even the ones that seem obvious. Consider how you might use an experiment to answer a question from your literature reviews and propose ideas to your student mentors and PI. This is how you stand out. Follow the sequence: build foundation, ask questions, make proposals, learn from mentors, conduct experiments, repeat. Your chief goal is to learn the fundamentals of scientific method and gain skills to practice it yourself.

By the second semester of sophomore year, you will be ready to make an important decision, which is 1) should you pursue a thesis research project in this lab or 2) should you find a different lab that is more in line with your interests. Do not continue in a lab or research area in which you are not happy; you still have time to pivot. Expecting to get everything right the first time is wishful thinking. Have patience and appreciate that there are many different approaches to scientific research. You will be a more interesting applicant because you actively followed your curiosity and sought diverse research experiences than if you continue working in a lab that doesn’t fulfill you. The quality of your work will show signs of disinterest, too.

You should be pursuing extracurriculars and developing leadership skills: non-profit consulting, writing for the school paper, mentorship, volunteer work. Remember, I said that medical schools do not care much about practical clinical skills–they will teach you those. They care more that you have demonstrated commitment to serving others, whether this is strictly in the clinical sense or out in the world makes little difference in the big picture. For example, I mentored an elementary school kid for 3 years during college. I assure you that the communication and teaching skills I gained from this relationship helped me prepare more for a career in medicine than another shadowing experience. Therefore, use sophomore year to expand your view on what it means to be an excellent physician and define those characteristics for yourself.

The summer after sophomore year is a time for growth. You’ve been building clinical and research experiences, have begun developing leadership skills through extracurriculars, and have worked hard to keep up with your grades. In my view, the next step is to pursue a summer research experience. Again, this recommendation is highly valuable for students that want MD/PhD, yet it will also distinguish students who are applying MD-only from the applicant pool.

To apply for summer research programs, you will need at least two letters of recommendation. First, talk with your PI and explain that you have a growing interest in pursuing MD/PhD. Especially if your institution is disconnected from a medical campus, pursuing summer research at an institution where you can learn how to bridge research with clinical medicine is critical. Ask for a strong and personal letter of recommendation. For the second letter, consider the other mentors with whom you have formed relationships. Who will speak highly of your potential as a physician-scientist? Ask for the second letter and start developing your CV and personal statement for the application. Note that you will need to submit this application by January of your sophomore year if you want to have the summer experience. I cannot recommend this enough.

One caveat to keep in mind, however, is that if you’re invested in your research at home, there is no problem with spending the summer focused on your ongoing project(s). I think gaining exposure to a new research perspective, building community with other like-minded students, and broadening your network is valuable, but you are by no means disadvantaged if you choose to stay local. What’s most important is that you spend the summer of sophomore year gaining practical skills in the lab and honing scientific communication. Next, it’s time to put theory into practice.

Junior year — learning how to talk the talk and walk the walk

Junior year is when you start working more independently on your research, practice experimental design to solve problems, and develop your communication skills. You will experience failure during this time, which is essential. Experiments are going to flop, and you’ll have to figure out why. It is the problem-solving process that is critical for succeeding in MD/PhD admissions and demonstrating that you have what it takes to excel in medical school and MD/PhD programs. How will you respond to the adversity? These experiences will provide you with a distinct set of complementary skills from what you are developing in parallel through clinical experiences. The combination of these skill sets is powerful and recognizing this synergy is important for the Why MD/PhD essay.

Tell your PI that you are motivated to present your research at science talks, poster presentations, and conferences as well as apply for scholarships like the Goldwater Scholarship. Seek out these opportunities. You must advocate for yourself. Ask your PI what needs to happen for you to earn a publication. Propose a project that you can submit for an undergraduate thesis and work together to refine it. This will focus your work, demonstrate initiative, and provide you checkpoints to work toward your goals. Aim to present your research frequently and keep track of your presentations in your CV.

During this time, continue deepening your relationships with mentors. Provide value without expecting anything in return. Be proactive and kind. The mentors learn from you just as you learn from them. When the time comes to ask for letters of recommendation, you will be grateful that you invested in forming great relationships.

In December of junior year, start planning for the MCAT. Take a relatively lighter course load during the time you are studying. Use UWORLD and AAMC question banks as well as practice exams to prepare. Don’t overload with resources; the ones I mentioned are more than enough. Study consistently for 3–4 months by answering question sets with mixed topics and reviewing your incorrects. You will find on UWORLD that the explanations for the incorrect answer choices are as valuable as the correct answer explanations. You should study both. Take the MCAT by early April of junior year; I recommend studying as if you only have one chance, but you should budget time for a retake in early May if, well, life happens. Aim to score 515, but I found success with an MCAT score of 510. Don’t retake a 515. Consider your full application as well as the cost/benefit before retaking a score 510–515.

During the spring semester of junior year, identify the writers of your letters of recommendation. This is when the MD-only students get a relative break in application preparation. For MD/PhD, you need at least 6 letters: 2–3 letters from research mentors who can praise your scientific potential, 1–2 letters from clinical mentors who know your aptitude for patient care, 1 letter from the premed committee, and 1 letter from a mentor who can discuss your leadership skills and personal traits in an extracurricular setting. Make sure each person knows you are applying for MD/PhD and craft the letter accordingly.

The AMCAS application opens May 31st. Write the personal statement first and take time to get this essay right. It should take multiple drafts. As an MD and MD/PhD advisor, I’m obviously biased, and I think getting a coach is incredibly helpful. The direct feedback I received from mentors allowed me to make average essays excellent, and I needed guidance to identify what about my story was key to highlight. If it wasn’t for coaching, I would’ve likely submitted essays that missed the point. Since I believe it was my storytelling that made the difference between acceptance and rejection, I’m certain that this preparation made a difference.

The personal statement, why MD/PhD essay, and significant research essay each require a distinct approach. So long as you have a good MCAT (>510) and GPA (>3.7), the big 3 essays and letters of recommendation are the most important elements of the application. I argue that having strong essays and letters is more important than incrementally higher test scores and GPAs. Numbers get your foot in the door; storytelling gets you a seat at the table. Take time to develop your personal narrative in written and spoken words. You will be telling your story across many media, through different versions, and to diverse audiences for the next 8 months. Don’t wait to get good at this skill.

For both MD and MD/PhD programs, submitting your application early is an advantage. Aim to submit the primary application by July 1st. It’s not a hard deadline, but it’s a good goal. This allows 2 weeks for application processing, and 2 weeks to start receiving secondary applications from your school selection. You will likely receive secondaries from most schools you apply for, so prepare to be overwhelmed. Since you should aim to submit secondaries within 2 weeks of receipt, some students find it helpful to stagger their school selection: apply for your top-choice 10–15 programs initially, then add second-tier 10–15 schools 2 weeks later. This allows you to focus your energy on top choices without the stress of returning all 20–30 applications within 2 weeks.

Senior year — the admissions cycle is in full swing and it’s time to focus

The secondary application is crucial for getting interview invitations. You will start receiving these applications in mid July — August. The story you started telling in the primary application now needs to be refined further. Who are you, what have you achieved, and how will you contribute to the program and medical school class? As an MD/PhD applicant, your job is even more involved. You must also respond to essay prompts about why you want to pursue MD/PhD, what your research interests are for graduate school, and which faculty members might be good matches for your interests. This is school specific, and you should avoid writing generic responses. Do your due diligence.

After submitting your secondary applications, the waiting game begins. Some schools will ghost you; others will offer conflicting interview invites. It’s a confusing time. You must keep composure, embrace uncertainty, and prepare for the opportunities that do come. The story you’ve been writing now needs to be communicated in an interview context. When someone asks you, and I promise they will, “tell me about yourself,” your answer should be polished and compelling. Practicing mock interviews is essential to rid yourself of the jitters and fine-tune your responses in various scenarios. Identify your weaknesses and fortify them. MD/PhD applicants have 2-day interviews in which you will speak with many students, faculty, and administrators. Every interaction is an interview. Even that short conversation with a grad student — if you leave a good impression, it will trickle back to the right people.

In addition to developing your personal narrative, you must be able to explain your research at multiple levels. This is one reason why you pursued all those opportunities to present your research in junior year. How do you explain your research to a person outside your field? How about for a person in your field? What would you include in an elevator pitch and how would you adapt it for a chalk-talk format? Can you talk the talk?

Personality and personal connections go a long way in these interviews. All the office hours, relationship building, expanding your worldview, and extracurricular activities you pursued have prepared you to relate with others. Demonstrate communication skills, empathy, humor, enthusiasm, and kindness. How you make the interviewer feel is more important than what you say. Know the answer to “why should we pick you?” without conveying ego in the response. You’re going to be anxious; it’s normal and you should anticipate these feelings. Be confident that you’ve done the work to prepare and that you are exceptionally qualified to be interviewing for this position. The way you build that confidence is through practice and feedback. With each interview experience, you will become more comfortable and prepared for the unexpected. Your ability to improvise and adapt to challenging interactions will astound you.

Be sure to keep up with your schoolwork and push towards completion of your research thesis, too. You will know about the dates of all your interviews by the end of November, which will take place through February. Being waitlisted stings, though you should not let that distract you from the next opportunity. It’s out of your hands. If you have important updates to provide the administration (e.g., a new publication), you can share that information. However, don’t bombard the admin with questions about your likelihood of getting off the waitlist. Demonstrating patience during this time is more important. It’s difficult.

But the day you receive that phone call or email… the one from the MD/PhD director contacting you to say you have officially been offered acceptance into their program provides a feeling of joy worth being patient for. If you put in the work, it will come. It’s a competitive process — I’m sure you already know it. Persistence and perseverance in the face of rejection is part of the game you’re signing up to play. The rules are unclear and often seem unfair. It’s a huge investment of time and money, but for MD/PhD especially, the payoff of free medical school, a stipend, and unforetold career flexibility are worth it.

Post-Bacc — the gap year(s) that could change your life

However, many students have their epiphany for MD/PhD late in the game. That’s completely fine, and a less straightforward path adds texture to your application. Don’t be afraid of the gap year(s). I took one gap year, and it was the best year of my life– admittedly, I was living in Morocco with my family and doing research on the side. Check out the blog post about how I deferred my acceptance; it’s my favorite.

If you don’t have at least 2 years of quality research experiences by the time you plan to apply for MD/PhD programs, I recommend that you consider post-bacc research for 1–2 years. I know, you’re “in a hurry to get life started,” but remember that the rush is an illusion–this is life. Post-bacc research offers protected time to make money, live somewhere new, and dive deep into the research. This will allow you to expand your views on what it means to conduct lab research and provide you with more refined insight into the work that inspires you. Then, you will be equipped to develop your vision for graduate school and express it more effectively in the application.

Going through the MD/PhD application cycle prematurely is exhausting and demoralizing. This goes back to recognizing your strengths and weaknesses and waiting for the right time to go all in. The time off from studying for exams and time spent working in the “real-world” will refresh you. This fresh perspective combats burnout and will allow you to jump into medical school recharged and ready for the onslaught of studying and examination. You will be more capable, mature, and competitive to reach your dream program, as a result.

Conclusions — a story with more chapters

This MD/PhD playbook has enough for you to get started and make important progress toward your goal of acceptance, but it is incomplete. There are nuances and details at each stage, with non-obvious lessons replete at each step. That’s why I’m committed to writing more chapters that will provide deeper insights. I’ve already started; I have an MD/PhD blog that provides details on many of the topics discussed. I want to hear from you and help you because I know how challenging it can be to navigate this complicated process.

I’m offering a free 1-on-1 advising session for MD and MD/PhD admissions to anyone who sends me an email saying they read this post. I’m also offering a free course called the MD/PhD Academy where I’ll teach you how to prepare for each component of the MD/PhD application as well as a free personal statement workshop. I encourage you to sign up. You can catch me on Twitter @jakeokhous and Instagram @madrasaadvising sharing short-form content and at the MD/PhD blog, where I share everything I wish I would have known earlier. The sooner you begin preparation, the better, especially when it comes to lab research.

Send me an email at info@jakekhoussine.com. I look forward to it.

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Jake Khoussine

I’m a first generation student in my 5th year of MD/PhD training. This is everything I wish I knew earlier. I hope you find it helpful, feel free to reach out.