Application Process
 
“The early bird catches the worm.”-Anonymous 

One of the most important aspects of the application process is to accomplish tasks in a timely fashion. This means taking the April MCAT, sending in transcripts early, and starting to work on your essay, including the personal statement. While it is not necessary to send in materials on the earliest possible date, it is to your advantage to be early throughout the whole process, including finishing the primary and secondary applications. The earlier you secure letters of recommendation, the better. You should even start writing the infamous “M.D./Ph.D. essay” that will focus on your motivations for the combined degree and previous research experience and accomplishments. This helps expedite the admissions process. Chances are that you’ll be granted interviews at an earlier time.

That being said, we want to emphasize that you really need to send in your application materials WHEN THEY ARE READY. The application process is about presenting yourself in the best possible light. This means taking the time to revise and polish your essays, making sure grades are properly reported on transcripts, tidying up secondary applications, and ensuring that you are giving yourself the best possible chance by starting off on the right foot. Therefore, we recommend that you don’t rush and do a poor job, but take the time to really think about your responses to questions and to describe your research and motivations for the M.D. and Ph.D. degrees. After all, Rome wasn’t built in a day.

As other premedical texts cover the basics of the admissions process in great detail, here we will be approaching the subject from a perspective relevant to M.D./Ph.D. applicants. For more detail on the specifics of the AMCAS and other components of the application, we refer you to the AAMC web site: http://www.aamc.org/students/start.htm
 
 
AMCAS: Laying the Foundation
 
The first step is to complete the primary application using the American Medical College Application Service. Most American medical schools with M.D./Ph.D. programs take part in this centralized service. It is designed to be a standardized application that is submitted to all of the medical schools to which you choose to apply. Currently, the latest version is online (to the chagrin of many premedical students). Given the fluid nature of Web media, the application will likely evolve considerably over the next several years.
A new addition, highly relevant for M.D./Ph.D. applicants is the section that includes checkboxes relating to combined degree interests. Medical schools will now see that you are applying M.D./Ph.D. even before they decide to send out secondaries. The catch is that there are separate M.D. and M.D./Ph.D. boxes, and thus the applicant must decide early on whether to pursue M.D./Ph.D. or M.D.-only. It is presently unclear as to how this will effect admissions, but it is unlikely that schools will discriminate between types of applicants in this initial process (UCSF does not, for example). There is pressure from M.D./Ph.D. programs to find out how many applicants are applying this route, and thus AMCAS is likely to make revisions in the coming years. For example, the following questions could very well make their way onto the AMCAS application:
 
1) Briefly state how a combined degree would satisfy your career goals.
 
2) Please describe your research experience including the nature of the research problem and your role on the project.
 
A major decision to make at this point is to how many schools you should apply. We recommend that you first do some research by browsing various schools web sites and seeing 1) if they have an M.D/Ph.D. program, 2) if the M.D./Ph.D. program is an MSTP (visit http://www.nigms.nih.gov/funding/mstp.html), 3) the procedure for applying. Schools vary considerably in their requirements and application procedures. You should also think if you could actually see yourself at that particular school. For example, if you don’t like frigid weather, your research interest is in a particular field, or you want to apply to programs with particular strengths, that might narrow the field. Don’t apply to programs you really would not attend. It will be become obvious that you aren’t interested.
However, a word of caution: don’t eliminate too many options at this point. It is better to overshoot the number of schools to which you apply. Often it takes actually the firsthand experience of visiting the school (i.e. on interviews, revisit weekends, etc) to determine if you would attend. M.D./Ph.D. applicants traditionally apply to fewer schools than their M.D.-only counterparts, usually somewhere in the range of 10-15. Perhaps this is because they have stronger academic records. Or maybe there are fewer schools in which they are interested. The point is that you’ll have to decide to how many you will apply by assessing the strength of your academic record, research experience, letters of recommendation, and other factors.

Given that the AMCAS is a primary application received by medical schools, and is NOT a graduate school application (or M.D./Ph.D. application for that matter), we suggest that you save detailed descriptions of your research for the M.D./Ph.D. applications that come with secondaries. Instead, write essays such as the personal statement with medicine in mind. It is fine to talk about science and your research background,but remember that medical school admissions committees read these essays and may be a little worried if you present yourself as only interested in science. You might mention something about the interface of science and medicine in your essays, but the main focus should be on the experiences that have led you on the path to becoming a physician. Remember, there are no steadfast rules and individual experiences have been highly variable. Usually it is best to present yourself as a thoughtful individual with a passion for both medicine and science. You will be required to carefully bridge the dichotomy between degrees many times over throughout the application process (not to mention in your career as a physician-scientist). So tread lightly and use your common sense.
 
 
Secondaries
 
So, you have finally finished the primary application and have gotten to breathe a big sigh of relief. Enjoy it because when secondaries hit your mailbox, you’ll be taking on a full-time job. Not only will you be required to fill out the multitude of medical school secondaries, but you’ll have to complete the additional enclosed M.D./Ph.D. applications. This is by no means a trivial task. Although you will be tempted to make a half-hearted effort here, don’t forget that the secondaries are at least as important as the AMCAS application.

Schools differ in their procedure for sending out secondaries. Some screen applicants based on the primary application, but others automatically send a secondary to all who use AMCAS. Secondaries typically ask for additional information, including essay-style responses to profound questions such as “What makes you special?” They typically want additional personal information, volunteering hours, research experiences, etc. Don’t take these questions lightly. It is best to work on one application at a time, in a thorough manner. You will see that secondaries get exponentially easier to complete with each additional one, as you can cut and paste essay responses. Some secondaries ask if you are applying M.D./Ph.D. Others ask to specify either 1) M.D., 2) M.D./Ph.D. only, or 3) both. There usually isn’t a disadvantage to specifying the third option, but if you select the second, you probably won’t be considered for just the M.D. if you don’t get in for the M.D./Ph.D. program. Yet other secondaries don’t ask you to specify, and simply include an additional application specific for M.D./Ph.D. applicants. You are still required to fill out everything, including the secondary.

Frankly, the process of what to fill out is somewhat confusing for M.D./Ph.D. applicants. Most secondaries are fairly straightforward, even if applying M.D./Ph.D. However, some do not have an integrated process, and thus you must apply separately to both the medical and graduate schools. We recommend that you check with your schools of interest for the proper procedure. Also, if you have any questions, feel free to give the program administrator a phone call. Unlike M.D.-only admissions officers, M.D./Ph.D. administrators deal with a limited group of applicants each year. Consequently, they are considerably less stressed and often more willing to go the extra mile for you.
 
 
The M.D./Ph.D. Application
 
The M.D./Ph.D. application that is typically included with secondaries will most often ask for your personal and contact information, coursework, MCAT scores, GPA, research awards, publications, names of research advisors who are writing your letters of recommendation, and an essay describing your past research experiences, your career goals, and why you want to pursue an M.D./Ph.D. program.

Don’t simply repeat the AMCAS section for awards and honors, but do include items relevant to research. The idea is to convey a sense of research accomplishments. As far as we’re concerned, no award is too big or small to list. Some will be recognized nationally (i.e. Westinghouse, Howard Hughes, etc), but others you’ll have to explain during interviews if asked.

As for publications, there are many different formats in which you may have presented your work. The best situation would be to have one or more manuscript publications in scientific journals, with full literature citations. You could even include reprints with the application, if available. However, most applicants do not have publications. Many have abstracts which can be cited using the appropriate format. Also, research presentations or conferences attended can be listed if you presented work either in lecture or poster format. These are not technically publications, but would be of interest to admissions committees because they show experience in various forms of scientific communication.

The M.D./Ph.D essay should discuss primarily your interest in science, but also some information on your medical interests. Be sure you know why you want both degrees and provide evidence to back up your assertions! It is critical that you show your development as a potential scientist through concrete examples. You want to convey a sense of maturity. We recommend that you weight your discussion on the side of science,as you had the opportunity in the AMCAS application to talk about medicine. It is highly recommended that you treat this essay with care equivalent to that you showed with your personal statement.

Try to describe your research experiences from a larger perspective. Admissions committees don’t want to hear about making buffers, doing PCRs, running gels, etc. Instead, they are looking for evidence of critical thinking, level of contribution to a project, independence in the laboratory, scientific participation (i.e. conferences, presentations, seminars, etc), and knowledge of the scientific process. Most importantly, they want to see that you can communicate complex scientific topics in a manner that an educated person (i.e. not an expert in the field) can understand. Avoid unnecessary use of acronyms and abbreviations and try not to sound too technical. You’ll get a chance later in interviews to explain the project(s) in gory detail (if they ask you to do so).

It is usually a good idea to have several people read your essay to help you revise. This should include those familiar with your particular projects (i.e. your advisor, postdoctoral fellows, graduate students, technicians, etc). Never underestimate the value of revision.

Again, take your time on the secondaries, but try to be as efficient as possible. The ealier you turn them in, the faster you’ll be granted interviews. However, the response time varies considerably, so don’t panic if the schools take a while to get back to you. Usually, postcards are included with your secondaries to notify you when all materials have been received. If you are unsure, bypass the M.D. admissions office and call the M.D./Ph.D. program directly to ensure the completion of your file.
 
 
Letters of Recommendation
 
Schools ask you to send letters of recommendation, which is typically done using a specialized service or premedical committee at your school. If you have graduated already, you may have to ask your professors to send letters directly to individual programs, along with evaluation forms included with the M.D./Ph.D. application. You will often be required to send separate sets of letters for the medical and M.D./Ph.D. applications. We recommend that for the latter, you seek letters from those who can best assess your potential for a career in research.

Admissions committees desire an outside perspective on the applicant’s strengths and weaknesses. Try to get letters from professors who know you well. In the laboratory, often the day-to-day contact is not with the principal investigator (P.I.), but a postdoctoral fellow or graduate student. Though P.I.s are usually very busy, attempts should be made throughout your laboratory experience to meet and talk about your projects and career goals. The amount of personal contact you receive will depend on several factors, including the size of the lab.

How do I ask for a letter, especially if I fouled up in the lab? Take Jeremy’s experience as an example:
 
I started working in a lab during my freshman year of college and one of the first things I had to do was make a stock solution of ethidium bromide (a known mutagen). My P.I. was in the lab at the time and therefore I was really nervous. I was kind of shaking and ended up spilling half the bottle of purple powder all over the balance and weighing area. My face went bright red and I could sense every member of the lab staring at me. Fortunately, my P.I. noticed my embarrassment and was compassionate enough to actually helped me clean it up himself. I thought I was a goner for sure! Despite this incident, I ended up working in that lab during all four of my undergraduate years and I have no doubt that my advisor's glowing letter was instrumental in helping me get into several M.D./Ph.D. programs. Now when I look back at my trials and tribulations, missteps and mishaps, bumbling and clumsiness in the lab, I just laugh. Don't take it too seriously. In the beginning, everyone knows that you are new and still learning. People honestly don't think about it as much as you think they do. I'd say that if you have contributed something meaningful to the lab and your advisor can write about your hard work, dedication, and potential, then you will likely receive a great recommendation.  
 
If you want to talk with your research advisor, a good way to go about it is to knock on the door and ask if there is a good time to meet. Be up front and convey what you want to discuss. The best thing to do when seeking a letter is to ask directly: "Do you think you would be able to write a strong letter of recommendation for me?" Your advisor will most likely give you an honest answer. Make sure you supply a curriculum vitae (c.v.) and a personal statement that outlines your interests, experiences, and goals. You should meet and discuss your interests and goals, which will give your advisor more to write about in the letter.

You absolutely want the best research letter possible. A factor to consider also is the status of your advisor in the scientific community. A letter from a well-known P.I. who publishes well will probably give you an advantage in the process. However, most applicants do not come from big-name laboratories. What is most important here is the quality of your letters, not necessarily who writes them. Of course, a letter from a P.I. is usually weighed more heavily than one from a postdoctoral fellow or graduate student. However, an additional letter from a postdoc with whom you have worked closely could offer additional and perhaps more personal insight.

Whoever you get to write your letters, make sure you give them sufficient time to make them great. Usually a month is the standard waiting period. Don’t ask the day before the letters are due, when your P.I. has a huge grant due the same day. Faculty usually run extremely tight schedules and will grow very impatient with pushy students demanding letters.

The key to obtaining successful M.D./Ph.D. letters is to choose people who can describe your research accomplishments, ability to succeed inresearch training, and potential for an excellent career in science.