A Memorable AMCAS Primary Application

The Primary AMCAS application opens officially in early May, and you can start submitting the application around May 31st. If you are following the timeline I’ve provided in How to get into MD/PhD programs, then you should have already begun writing your personal statement when the application opens. You should also have already identified and notified the 6 writers of your letters of recommendation a couple months in advance, and they should be aware that you need a letter that highlights your potential specifically for MD/PhD training.

While the big 3 essays and letters of recommendation are by far the most important components of the AMCAS primary, there are several additional sub-components that you will need to submit. The goal is to further highlight your personality, leadership experience, interests and hobbies, and path to the MD/PhD. In this article, I will address the following sub-components:

1) Letters of Recommendation

2) Work and Activities

3) Most Meaningful Experiences

4) Disadvantaged Essay

5) School Selection

Letters of Recommendation

You need 6 letters of recommendation. This is different from the requirements of MD admissions. Many programs will allow you to exceed 6 letters if they come from research mentors. Do due diligence on each program to see specific requirements.

How should you divide the 6 letters?

• 1–2 from clinical mentors
• 2–3 from research mentors
• 1 from premedical committee / letter packet
• 1 from nonacademic mentor

What’s the strategy?

Your clinical mentors should write about your exceptional patient care skills, examples of empathetic interactions, and curiosity about the underlying mechanisms of physiology and pathophysiology. It must reveal that you are the type of student who wants to understand the underpinnings of health and disease. These letters should convey your dedication to medicine and how you have showed up consistently and reliably with a desire to contribute to patient care. It’s the little things that make a big difference. Bringing patients warm blankets, offering ice chips, and providing kind conversation, and going above and beyond to build rapport with patients and care providers alike.

Your research mentors should explain that you have tremendous potential to become a productive and effective independent investigator one day. They should say you possess creative energy and provide examples of how you exceeded expectations to solve research problems. The letter should remark on how you’re a team player and eager to share your knowledge with others. Work ethic and consistency are more important than intelligence. MD/PhD programs want students who have traits of sustainability and evidence of commitment. Demonstrate that you have been building your knowledge progressively and that you have been seeking opportunities to improve as a science communicator.

If you do a summer research program, which is about 8–10 weeks long, you should aim to ask for a letter of rec from your summer PI. This is a short time frame, so make a great impression. People are always watching. The PI will get intel from your grad student or postdoc mentors about how you’ve been performing. Make the most of this opportunity, and at the end of the summer, ask to present your research findings at a lab meeting. Talk with your PI about good conferences that you could attend to present your work. Maintain a relationship with your summer research PI, checking in on occasion and sharing updates from your research presentations of the lab work. Be a part of the research team.

With respect to the premed committee letter, it depends on the university and the premed organization how this is done. Since this is done more specifically for MD applicants, you need to be explicit in communicating with the premed advisors that your letter needs to address additional elements about your research accomplishments and potential. While you should have a relationship with your premed advisors throughout college, it is important that you set a time to meet with them in spring of your application year to discuss your needs for the MD/PhD application.

I graduated from the University of Oklahoma. The pre-med advisors did not have much experience with MD/PhD applicants; I was the only student to apply MD/PhD from my graduating class. Therefore, I had to take initiative to ensure that everyone was on the same page about what my letter needed to include. At most state universities, this is probably quite common. Don’t get caught off guard by waiting until it’s too late to have this discussion.

Finally, the nonacademic letter. Surely you have been involved in leadership opportunities and extracurricular activities both on- and off-campus during college. Who can speak to your potential as a leader? This letter should provide an accurate reflection of your potential as a kind, thoughtful, and capable physician-scientist. What are the qualities that make you an effective leader? What problems did you help solve in your community? What makes you such an excellent communicator? How will these characteristics translate into your career in science and medicine? Don’t leave the content of a letter up to chance. People are busy, help them help you. Be your own greatest advocate, with humility and patience.

Work and Activities + Most Meaningful Experiences

You can input up to 15 extracurricular activities, each with a limit of 700-characters with spaces. It’s short and to the point. What did you do and what lesson(s) did you learn that will make you a better physician-scientist? In addition, for 3 of the 15 activities, you can mark it as a “Most Meaningful Experience”, which allows you expand for another 1325 characters to tell a story. Choose these experiences strategically, and remember, you are aiming to create a cohesive narrative across each element of the primary application. Limit redundancy and highlight complementary strengths while demonstrating how you overcame weaknesses.

At least one most meaningful experience should be a research experience. Keep in mind that you addressed this, in part, for the Significant Research essay. The most meaningful experience is an opportunity to go deeper and explain why a particular research experience was so impactful in your trajectory. You should do the same for the most meaningful clinical experience. While some people argue that you should have 2 research experiences in the Most Meaningful section, I think it’s overkill. Do a good job in your Significant Research essay and there will be no question that research has had a meaningful impact. Instead, I encourage you to use one of the most meaningful essays to provide insight into who you are as a person. Good options here include mentorship, leadership, longitudinal community service and outreach experiences. Ask yourself: what activities have you been involved with that have prepared you to be a well-rounded leader and a diverse physician-scientist?

Here’s the rough format for inputting a most meaningful experience:

Thanks for indulging my creativity as I learn to use Canva.

Disadvantaged Essay

This is not a diversity essay. You can think of this in 3 categories:

• Socioeconomic
• Educational
• Personal

If you were raised under challenging circumstances, experienced learning disabilities, or faced personal hardships that suppressed you, this is where you express yourself. It’s not about making excuses or “woe, is me”; it’s about providing critical context for the person you are today. If you immigrated to the U.S. or had to take time off school for personal reasons, this essay is a good opportunity to describe the adversity you faced. A winning strategy for this essay is to not only describe the adversity and disadvantage, but also how you leveraged your circumstance positively to make the most of a difficult situation. As always, what did you learn and how will those lessons allow you to become a more thoughtful, empathetic, and capable physician-scientist?

Simply, if you’re uncertain if this essay applies to you, it probably doesn’t. Let me provide you with an example to clarify. You have 1325 characters with spaces.

Example:

During my years growing up in Albuquerque, NM, I struggled to stay focused academically since our neighborhood had substantial gang activity and high crime rates. I witnessed numerous robberies and gang-fights, but I kept out of trouble during elementary and middle school by working at my uncle’s car shop. The educational system in Albuquerque is abysmal, with an average high school drop out rate of 25%. My mother did her best to encourage my siblings and me to pursue a college education. After 5 years of financial hardship, my mother remarried were able to move us to a safer area in New Mexico. Inspired by my mother’s self-discipline and tenacity, I overcame my disadvantaged childhood and became the first in my family to obtain a college degree. As a first-generation college student, I have had to demonstrate strong work ethic and grit to acquire the resources to drive me, impassioned, to break down barriers and elevate others who have been disadvantaged like myself. I will never forget what it is like to grow up underprivileged, and I will work hard to find ways to give back to communities like the one I grew up in.

School Selection

A gift of the MD/PhD path is that your chances of being accepted into an out-of-state program are significantly higher than your MD-only peers. Take advantage of this to apply broadly to programs of interest. I applied to 12 programs, and I wish I had applied to more. It is expensive, however, so try to seek financial aid via the AMCAS Fee Assistance Program. See if you qualify here.

If I were to go through school selection again, I would have applied to my top 12–15 programs upon submission of my AMCAS, which takes about 2 weeks to process before you receive secondary applications. Once I completed the applications for my top 8 programs, I would have submitted my primary application to an additional ~8 programs. I think 20 schools is borderline overkill, but it’s unlikely that you will receive a secondary from all of them. On the chance that you do, you have the advantage of submitting them in a staggered fashion. Also, you aren’t obligated to return the secondary if you decide against applying. Keep in mind that submitting each secondary costs additional fees. Give yourself the opportunity to choose. The goal is to return the secondary within 2 weeks of receipt. Admissions committees review primary applications in a rolling fashion as they come in.

I hope this brief primer on primary application sub-components was helpful. Overall, don’t stress over on the details. Focus on excellent Personal Statement, Why MD/PhD, and Significant Research essays, outstanding letters of recommendation, and salient “most meaningful experiences”. If a disadvantaged essay applies, find the courage to express your story and demonstrate how you can overcome adversity.

In my next blog post, I will give you the ultimate guide to the secondary essays for MD/PhD applicants. Reach out to me on twitter @MadrasaAdvising or via email at info@jakekhoussine.com if you have any questions.