Medical School X v. Medical School Y

May 15 is rapidly approaching. For those who are not familiar with medical school admissions, May 15 is the date by which all applicants who are holding multiple acceptances must commit to one school. They can, however, remain on multiple waitlists in addition to holding the one acceptance. For those who are lucky enough to have multiple acceptances and are undecided, this looming deadline creates a lot of anxiety and stress. If you swing by the Student Doctor Network's pre-allopathic forums, you'll find numerous threads asking for opinions about which school to pick. I addressed this topic about a year ago, but I thought I would re-visit it now that I am just a few weeks from graduation.

One disclaimer: personally, I did not have to make this type of decision. I was set on where I was going well before May 15 came around. I chose to remain on a couple of waitlists: one at a "top 10" school that had no chance of moving, and another primarily for a special program that I ended up withdrawing from once that program was full.

In the end what has mattered most to me in medical school has been having a support network nearby. Medical school is rough and your free time becomes very precious. Had I not been in somewhat close proximity to the people that I care about, it would have been even harder to maintain those relationships. So location has mattered most in that regard.

Going to a school in a certain location may help you make connections that will enable you to stay in that area for residency. Medicine is a small world and I have heard residency program directors flat out say that they value a letter from a colleague at a program in the same geographic region whom they know over one from a "bigger name" place outside the region. A good percentage of medical students stay at their home institution for residency (anywhere from 20-30% at my school), so if you are desperate to be in a certain area for the long-term, going to school there may help.

How "fun" the location is has not been as important to me as I thought it might be when I was applying. I tend to prefer larger, urban areas. Once again, your free time is going to be very limited. It may be cool to be in a big city, but you may not have time to do much there. Having easy access to a decent gym, some outdoor activities, a few cafes for studying, some good cheap eating places, and an independent movie theater have been enough for me for most of medical school.

Debt is a huge consideration that may not seem that important when you are applying to medical school. There is this assumption that you will take out massive amounts of loans like most medical students do. And there is another assumption that you will pay them back in due time like most physicians do. Just keep in mind that it all adds up really fast. The private or public school in a big city with high cost-of-living may leave you with substantially more debt than a private or public school in a more rural area. With rising tuition at many state medical schools (UCs are a prime example), the debt load for students has increased dramatically just in the last several years. If you are offered a scholarship at a private out-of-state, it may be cheaper in the long run. In the end, most people take out the loans, do okay, and do not base their choice of school solely on cost. But you need to think about what you are signing on for, and realize that having tons of debt may make things you want to do down the road, like buy a home or have children, more challenging.

As I have mentioned before clinical training is really the most important thing to judge when evaluating a school. Your clinical experiences will be the backbone of your education and will most shape your residency applications. Try to talk to 3rd and 4th years to see how they feel about their clinical experiences. Are they treated well? Do they get involved and play an active role in patient care? Do they spend most of their time shadowing residents and doing scutwork? Very telling: ask 4th years about their experiences rotating at other institutions and with visiting students on their home services--did they feel well prepared for their away rotations? Did they feel better equipped to handle the clinical demands placed on them than other students they worked with?

Second looks can be a helpful way to evaluate a school or can be a fairly useless, propaganda-filled event put on by the admissions office. If you attend one, judge it critically. Know that the school is putting its best foot forward and try to get opinions from as many people as possible, especially those who have not "volunteered" or been "selected" to talk to you about the school. Remember, some of the people there with you may ultimately be your classmates, but many will decide to go elsewhere. So the event may or may not be representative of what your class will really be like.

Curricula, facilities, early access to patient care, average board scores, and match list analysis are all less important things to consider when evaluating a school. The basic material to be learned is very similar at any US school and whether it is dressed up in a "systems-based" or "traditional" package is pretty irrelevant for most people. Problem-based learning has pros and cons, and most schools offer some form of it now. The bottom line is you will have to study a lot to pass your boards and your board score will depend a lot on how hard you work and how good you are at taking tests. Of course, if huge numbers of students are failing boards, that is a big red flag. Early clinical experience in free clinics and curricula is very nice and may help you see the big picture of why you are in medical school. But, by a few weeks into 3rd year it is not going to make much difference in your performance overall. Luckily, most schools now emphasize this in some way so it should not be a huge factor in the decision.

Match lists can give you some idea of where people end up geographically, but unless you know why people chose to make their rank list like they did, it is not that helpful. For example, let's say School A in California is well-known for having a strong residency program in Surgery and multiple graduates go into Surgery each year. In 2007 10 matched in Surgery and 8 of them stayed in CA. In 2008 9 went into Surgery and only 3 stayed in CA. Applicant X is desperate to go into Surgery and to stay in CA for residency. If Applicant X looked at the 2008 rank list alone, she might think School A is not a good choice for her career goals. What she may not know is that of those 9 Surgery applicants 3 were couples matching so staying in CA was not as important to them, 2 were desperate to leave CA and go elsewhere for personal reasons, and only 1 who did not match in CA wanted to stay but is happy enough going to a neighboring state to get to be a surgeon. So take match lists with a big grain of salt.

In the end, you will likely be fine at any US school you pick as long as there are not big red flags waving about and as long as you feel that you can be happy there.