Get an insider’s perspective on the admissions process as Dr. Ian Hagemann and Christina Twist M.Ed. talks about the admissions process at the Washington University School of Medicine. Below is a transcript of the conversation.
An Introduction to Christina Twist
I’m Christina Twist. I’m the Director of Admissions here at Washington University School of Medicine, and I have worked in medical school admissions for almost ten years now. I actually grew up in the healthcare setting. I have a family member who works in admissions for medical schools and so kind of was always in that environment and really enjoyed growing up, and seeing the relationships that you develop with applicants and current students, and so wanted to have a similar career in helping premeds kind of achieve their goals as they move through medical school and have really enjoyed that so far. I’ve been at Washington for about a year now, and before that, I was at Vanderbilt University in Nashville, Tennessee. So it’s a really fun journey. You get to meet a lot of really excited, passionate people who are interested in serving their communities and helping improve the healthcare system in the US.
An Introduction to Dr. Ian Hagemann
My name is Ian Hagemann. I’m the assistant Dean for Admissions at Washington University in St. Louis. I’m a pathologist by medical specialty. I’m interested in gynecologic pathology, breast pathology, and molecular genetic pathology as well. I actually attended WashU for medical school, so I graduated from Princeton with my undergraduate degree majoring in chemistry there, and then came to WashU as an MD Ph.D. student and didn’t necessarily set out to get involved in medical admissions. It’s just a series of opportunities that presented themselves. When I joined the faculty after my pathology residency, I did volunteer to serve on the admissions committee and realized first that it was a lot of fun to talk to the applicants. It was also an opportunity to really make a difference in their life as they pondered their next decision. And it occurred to me that admissions had a big role in my life too. It had given me the career, profession, and academic home that I have today. So it was very rewarding to get involved in admissions. And over time I happened to be presented with opportunities to take some leadership roles. This brings us to the present day. My other role in the curriculum is that I’m the lead of our genetics and genomics thread for our new Gateway curriculum.
So I’m involved in all three phases of the curriculum and it’s been great getting to know the students a little bit more in the classroom setting. We launched the Gateway curriculum in 2020, so it’s been about two years that we’ve been doing that.
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What Makes A Pre-Med Applicant Stand Out?
We get a lot of applications at WashU. We’re fortunate to have about 6000 people designate WashU on AMCAS every year when they apply. So we do get to see a lot of files. There are a couple of things that are pretty standard in common from one file to another. And I know that applicants do want to stand out and find the thing that will make them distinctive. When we read a file, we’re looking to understand the students’ voice where they come from, what their motivations are, and what makes them different. I don’t want them to invent something that will be different just for the sake of difference. But everyone has their own trajectory. And I have to say we do get a lot of files in which the applicant says that they discovered that they like science and want to help people, and they thought medicine was the best way to do that.
And if that’s true I want to see their exploration. I want to see how they tried out or learned about different professions, what they’ve done in science, and what they’ve done in the service realm, not necessarily community service, but something that involves serving those who are in need or who are part of the community. What makes an applicant stand out is that you can hear their distinctive voice in their file. So that voice should come through clearly. We’re not looking for boilerplate applicants who have carbon copied themselves from what they think that a school is trying to hear. I have to say there are certain things that are kind of common parts of an application. So almost all of our applicants have spent some time in the medical setting. Almost all have done some service. We do need those things to be there, but we want to get to know them and hear their voice. And the best files, that voice really comes through loud and clear.
Yeah. So I would agree kind of with what Dr. Hageman shared. And I think for me, we and many medical schools really focus on doing a holistic review of our applicants. So considering all the information that an applicant is providing about their experiences, their attributes, and metrics like MCAT and GPA, it’s really important to consider all of those. And we talk about in the admissions space in general, well-rounded applicants and what that looks like, and having kind of experiences in all those areas, which of course is important. But I also like to think of looking for applicants that are kind of spiky, almost like sea urchins. So we’re also looking for people who are passionate about something, and hopefully, if they’re going into medicine and health care, it will be related to that. But we have lots of students who also have passions outside of that. So being able to share that part of themselves with us in their file and kind of get more of a picture of who is this person, what drives them, I think really helps an applicant stand out to me and gives me an idea of who they are before we get a chance to meet them in the interview phase of the admissions process.
What Are Some Recent Changes to the Medical School Admissions Process?
Sure. Yeah. So that’s a good question and I think obvious elephant in the room – COVID and virtual learning and shadowing and kind of all of that’s impacted us. So certainly having to transition to virtual interviews for the admissions process, we’re headed into our third interview season. Now it will be virtual. So that has been a big change that we’ve seen. And then kind of on the flip side of that, for applicants, opportunities that previously might have been in person went away for several years. So shadowing experiences, getting to kind of really observe and see and maybe even be involved in that patient-physician interaction and relationship. But by the same token, I think that has also provided a lot of opportunities to wear. Now, as an applicant, you aren’t necessarily having to travel for each and every interview to the schools that you’re interviewing at. You can attend via zoom. And so maybe that makes the process a little bit more affordable for you. It helps you kind of differentiate what your top schools might be as you go through that process, so that then when you get to a phase where you are actually able to visit, you can spend your time and dollars wisely as you try to determine what’s going to be the best fit for you.
So I’d say that’s one of the biggest changes I’ve noted from an admissions process in point no, let Dr. Hagemann maybe speak to that a little bit, as well as changes that we’ve seen in applicants over the years.
Medical school admissions today really are holistic. We’ve bought wholeheartedly into a new concept, model, and paradigm holistic Admissions holistic review that looks at experiences, attributes, and metrics. We’re looking for applicants who are well-rounded in those three respects, who have all three of those things. Experiences are mostly things that you’ve chosen for yourself that let you show your interests, that you develop your talents. Attributes reflect the background of the student, where they come from, what their environment has been like over time, what they’ve come through or based on, and what distance they’ve traveled. And then metrics are quantitative things that we can observe, usually from the academic record. For the most part, all three of those have to be in good proportion with one another. It’s okay for one of those to be a little bit weaker if the others are equally strong. I think about it as a tripod or maybe a three-legged stool where it’s going to balance almost no matter what. And it’s guaranteed that one of those legs is going to be a little bit shorter than the others. That’s okay. If one of them is much shorter, it’s not going to be very comfortable to sit on. In the 20 years that I’ve been observing medical school admissions, I think the applicants have changed, for one thing, in that they are more likely to have taken some gap time. It used to be relatively common to go straight through from college into medical school. At WashU, a minority of our students, maybe 25%, had taken a gap year. Now it’s the majority, more than 50%. I don’t have a percentage, but that’s especially true for the MD – Ph.D. students who are a big part of our cohort here. About a quarter or fifth of our classes, are MD – Ph.D. students, and the majority of them have taken one or more years out.
I know when I was an applicant I was in a big hurry to get on with it. I was excited to go to medical school. I wanted to go straight through, and that’s what I did. I actually regret personally not taking some time off. I’ve now asked hundreds of interviewees how they decided to take gap time and if they’re happy they did it. And I haven’t yet had anyone who admitted that they wish that they had not taken a gap year. Everyone has found it valuable. So I think that for someone who’s deciding what to do, I think if you can go ahead and do it, it’ll strengthen your application and you won’t regret it, even though you’re excited to get started. Medical school admissions right now are very concerned with fairness. I think that’s a good thing. Everyone wants to be treated fairly. We’re becoming much more aware of the role of bias and structural determinants of applicants’ outcomes and trying to correct those as best we can. So there’s a lot of emphasis on creating a fair process for every applicant, following it for every applicant. And as I say, I think that’s a good thing. There’s sort of an image about medical school admissions that it matters a lot who you know, and someone can make a phone call for you, and that really is not true anymore.
There’s also not a particular GPA or MCAT score that will get you into medical school the way there was probably 25 or 20 years ago. It used to be that if your metrics were high enough, you kind of just waltzed in through the door. And that’s really not the case anymore because there are lots of applicants with amazing metrics. So we’re looking at all three of those components of the tripod, not only at our school but certainly here. So there have been some changes. I think they’ve improved the process. We are more aware of the role of physicians in serving a leadership role in the community, in helping to promote disease prevention, and health promotion, and to combat structural determinants of ill health in the community. So we’re looking for students to understand those things, and that’s also somewhat of a difference from prior years. We’re looking much more to see how much experience the applicant has in working with underserved populations, and most of our applicants have some contact with that part of the healthcare delivery system.
What makes Washington University Medical School Special?
So WashU is an amazing place to go to medical school. There is a new curriculum here, the gateway curriculum that was rolled out in 2020.
We completely reimagined what the medical school experience was going to be like from day one through your graduation day. There’s a lot of information about this on the web, on our website. We have various videos and we’d love to tell any applicants about them. But in brief, we’re emphasizing much more what we call Helical learning the process of gradually building upon the knowledge that you have acquired the skills that are involved in becoming someone who thinks like a physician, not only in learning things and, quote-unquote, regurgitating them. So we’ve decompressed the pre-clerkship phase. We’ve moved some of the basic science content that used to dominate there to what we’re calling phases two and three, the clerkship and post-clerkship pre-specialization phases. We’re emphasizing structural determinants of health, health, equity, and justice, and the advocacy role quite a bit more there’s a lot more teamwork and active learning. So this curriculum is very contemporary, very evidence-based, very interactive, very student-focused, very sustainable, and very technology driven. To me, that’s one of the main reasons why a student would be attracted to coming to Washington University for Medical School. The other thing is that we do have a mission of training academically minded physicians.
We don’t expect that our graduates will go into academic career trajectories. We don’t specifically encourage them or discourage them from following other pathways besides academic medicine. But we want them to have an academic mindset and to be scholarly about their work. We want them to be curious about what the evidence says to guide their practice. We want them to contribute to the body of evidence if they can. Our students tend to be very interested in research, which doesn’t mean bench research and pipetting necessarily. That can be a lot of different things. But we do try to encourage our students to participate in research while they’re here.
Yes, I think Dr. Hagemann just gave you all a lot of great answers about the school and the curriculum. One thing that really stands out for me is our location. So we’re in St. Louis, Missouri, kind of the middle of the country. We are a private school, so we draw students from all over the US. As well as internationally, which really helps us build a diverse class of people, bringing a wide variety of experiences with them, so that you’re not only learning from your faculty, but you’re learning from your fellow students and teaching your fellow students based on your own experiences, which is great. And then you have the city of St. Louis, where we’re based. And so that is a really neat city. It has a, first of all, very affordable way of life compared to some of our coastal competitors, which is nice. But we’re right next to the largest urban park in the US. We’re very close to outdoor things if you are someone who enjoys hiking, camping, and whitewater rafting. We also have a great art scene. So many of our art museums and history museums are free, which gives you a chance to take a little bit of time off or away from medical school.
We think balance in your medical education is important. You need to have the time to recharge, get reenergized, and can bring your full self to your classes and your patients. And then the food scene is really incredible as well. There are different neighborhoods all over the city that have great restaurants, coffee shops, and fun places to study. The climate is very mild, kind of throughout the year we get some of each season, but nothing to the extreme. So it really is a great place to live and work and go to medical school. And we find that many of our graduates enjoy it so much that they want to stay here for residency and kind of continue their medical journey here at Washington St. Louis.
What is Your Biggest Piece of advice for Medical School Applicants?
Yeah. So, the biggest piece of advice. This will sound maybe a little silly and a little bit like a no-brainer, but be aware of dates and deadlines. So many schools do admissions and application reviews on a rolling basis. So they’re reviewing applications kind of in the order that they’re received, and then that translates to how they send out invitations to complete their secondary or supplemental application, which then translates to interview invitations and ultimately translates into admission offers.
And so I think kind of being aware of those dates and deadlines for programs and schools that you’re interested in, trying to have maybe a two-week turnaround time on any requests that you receive to get that information in kind of keeps you in the competition from a timing standpoint pool of any school’s admissions process. I think. Additionally, being willing to reach out with any updates to your application throughout the process can be helpful. We know that when you hit submit on Amcast that you do not suddenly stop doing things. Your life continues as a premed. You might be on something that becomes a poster, presentation, or publication, or maybe you start a new shadowing experience or win an award. We want to hear about that and include that in your application file so that the committee can be kind of reviewing the most complete, most current information about you as they’re making decisions.
So I would encourage students to get to know the schools that they’re thinking of applying to and to make their list very carefully. There are a lot of schools in the past 15 or 20 years that have seen several new schools open that didn’t exist before. You can learn a lot from the school’s websites and social media without visiting. I would encourage students to talk to as many people as possible, graduates of different medical schools, members of different specialties, and people who have lived in different cities because there are so many differences, and the decision of where to go to medical school really does have an impact on the whole rest of your life. I would encourage applicants to check their prejudices and preconceived notions at the door. One thing that we’ve noticed at WashU is that we’ll meet applicants who say, I never expected to like St. Louis this much. I never thought it would be such a great place to visit or to live. They just hadn’t necessarily been here before. It wasn’t on their radar. And of course, there are those people who, after visiting, say, you know, that’s great, but it’s not for me, and that’s fine. We’re lucky that there are lots of great medical schools in our country.
So professionally, it’s my duty to encourage students to come to WashU. I want people to be down our door, but I’d actually like to tell applicants that there are lots of great schools. My other piece of advice would be to worry less. I think flying to medical school is a very difficult, expensive, stressful, and impactful time of your life. And I remember very well what it’s like to be in that position. It just really predisposes students to a lot of anxiety. This process is actually more humane than you think. It’s more student-oriented, it’s more student-driven. The schools are actually your advocates. It may not feel that way, but we’re really trying to achieve the best outcome for our pool of applicants as a whole. Of course, that means that some applicants might get news that they welcome, and some applicants might get news that they don’t. But the goal isn’t necessarily to get an acceptance at every school that you could possibly apply to, although that would be nice. It would also be nice to eat filet mignon for dinner every day, but I don’t expect to have a chance to do that.
And it’s the same thing with medical school. So make your list carefully. Do your homework. Apply to a wide enough range of schools. One mistake that I see is that students will choose all the schools in the same tier, and then they’ll be surprised when they get similar outcomes. It can be a little bit hard to know how your application is going to be received. For whatever reason, you don’t always get a lot of feedback. That’s just the way the system works. You don’t necessarily know why you weren’t accepted at a certain school or a certain group of schools. But unless you have some certainty for some reason about what the outcome is going to be, I think you should apply to a wide range of schools. And that way you get to learn more to visit all those places, either virtually or potentially in person, or even just through their social media. That will make you a more informed medical student and also give you some information for the next stage of your training, because you’re going to go on to hopefully serve an internship, residency, and maybe a fellowship, and not necessarily all in the same institution.
So you might as well talk to a lot of people and learn a lot about the industry while you’re laying the groundwork.
Additional Tips and Information for Applicants
So I could probably keep you here all day with different things that I’d like you to know about our school I think a big one for me though is there can be this perception in the medical school world by applicants and maybe even med students as well. Even though they’re existing in it a little bit more. That medical school is hyper-competitive and it’s every person for themselves and I’m not going to help you because that might be a detriment to me. And one of the things that I really love about WashU is the collaborative environment that we have here. So not only with the way we’ve set up grading for the new gateway curriculum, which is more focused on competency-based grading and kind of past fail and do we feel like you can move on to the next step and be successful, but how our students work together with each other, how they work together with faculty. In fact, many of our faculty view the students as peers. They’re going to and not too short of a period of time like it’s not too long a period of time be out there working together as physicians and so wanting to make sure that I can support you now and help you be successful.
So that I’m proud to stand next to you and call you a colleague I think is really meaningful and I hope that is true of all medical schools, but I know that is definitely the case here. And two, just even collaboration across the larger Washington University community. So, you know, we have the medical school, but then we also have an undergraduate university and other graduate schools, and different research that kind of crosses through those different groups still involves a lot of collaboration and community collaboration as well. So I’d say for me, the big thing, the first thing I would talk about when I asked this question is the amount of collaboration in our community.
So our students are the best. I would really encourage anyone to come to visit and get to know our students virtually these days, but whatever means they can. Our students are the best. They’re very dynamic, and productive, and they are a collaborative group. It’s an environment where we compete with ourselves because we’ve got a lot of highly driven people, but that isn’t cutthroat. The traditional image of medical school is a place where you have to climb To the top of the pile.
It really isn’t accurate anymore. Everyone is doing a little bit of something different in their career, so there’s room for everyone. I’d like to highlight a component of our Gateway curriculum called Explore. This is the idea that there are different identities or interests within medicine, even passions, and we would like our students to find their passion. We have four kinds of thumbnail sketches that we call Research, Teaching, Advocacy, and Innovation. And Advocacy includes the Global Health piece. So those four or five leaflets are the five core identities that we encourage students to explore and ideally kind of choose one as their academic home. But they can pursue several if they’re interested in kind of a secondary way. So every student is exposed to the core tenets of those four pathways research, teaching, advocacy, global health, and innovation. All four of them are strengths here in our institution. There are faculty mentors who can help to give students the foundation, and we encourage students to view themselves not just as a physician, but as a practitioner. One of those fields. I think that’s a unique component of the Gateway curriculum and something that helps you differentiate yourself as you move forward in your career.
So take a look at that. Take a look at all the opportunities. Student groups are very active here. Community engagement is huge. St. Louis is a city that honestly doesn’t have the best social safety net and public health care delivery. Barnes Jewish Hospital, which is our hospital partner, really is the hospital of the last resort in St. Louis. That’s the city of a lot of the care for underserved members of our community. So you have the opportunity to be right in the middle of that as a student at WashU, and that’s something that’s a precious role for us to be able to do.
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