The darker side of pre-med

The toxic culture of the pre-medical path

Sarah Farnand, Sports Editor

For many pre-medical students, dreams of practising medicine have been playing through their minds since they were children. It’s the allure of being able to save someone’s life, help a person feel better, or finally provide that answer a patient has been searching for. Of course, some people have other reasons for pursuing medicine, like taking home a high salary, pleasing parents, or satisfying the narcissistic desire to prove to themselves they are smart enough. By high school, many students are convinced that medicine is their dream career.

At least until university. In a study conducted by scientists at the University of Minnesota, researchers found that only 16.5 per cent of students who said they planned to go to medical school at the start of their undergrad actually graduated university with sufficient course work to do so. The study analyzed a sample of 15,442 students across 102 universities, all from various demographics and socio-economic backgrounds. In my own life, I frequently hear about friends who used to be on the “pre-med” track deciding to switch to another career path. While some students’ interests may have changed after arriving to McGill, others said that they were driven away by the toxic culture that pervades the community. Even for those still gunning for medical school, the environment can prove to be extremely destructive. As a pre-med myself, I have experienced this phenomenon in many different forms during my time at McGill. Whether my classmates ignore my questions in class group chats, refuse to provide help with assignments or labs, or just constantly try to one-up my accomplishments, being immersed in such a cutthroat environment has certainly taken its toll.

Sabine El Khoury, a D2 Dentistry student, had similar experiences in her undergraduate years. She recalled a time when she received misleading advice from another student about how to prepare for medical and dental school interviews. The student told her that they found preparation unnecessary—despite the fact that they had practiced for the interviews relentlessly.

“I have been lied to my face about something by someone who I thought was a friend,” El Khoury said in an interview with The McGill Tribune. “I asked them what they were doing and they lied to me just because of the competition. So I feel that [the environment] is toxic, and it is toxic unnecessarily because that person who lied to me didn’t end up getting into [medical school].”

The constant competition can be exhausting, agreed Alex Schneider, U2 Science, who hopes to one day become a surgeon. Currently, most Schneider’s friends are in the faculty of Arts.

“I just am not friends with a lot of pre-med students because I feel like all they want to think about is pre-med,” said Schneider. “I have put in the time and the work. But when I want to hang out with my friends I do not want to think about class and be in competition with all these people, because I think that’s where it can be mentally exhausting.”

Part of the problem is the extremely low acceptance rates at most medical schools, which tend to require very high GPA and Medical College Admission Test (MCAT) scores. At McGill, the average undergraduate GPA for someone entering the Faculty of Medicine is 3.99 for those outside of Quebec, and 3.91 for those who attended a Quebec university. At the University of Toronto’s Faculty of Medicine, the average undergraduate GPA is a 3.95. Getting admitted to these schools is unlikely, given their meagre acceptance rates of 5.6 per cent and 8.3 per cent respectively. Such high standards can motivate and reward desperation, intimidation, and sabotage, instead of collaboration and kindness.

Of course, medical school is extraordinarily difficult, and high standards are necessary to ensure that a student has the skills necessary to be successful. However, some schools like the University of Toronto have attempted to level the playing field by simply requiring a minimum MCAT score, but not evaluating it as a factor during admissions. Indeed, a more holistic approach might help create more well-rounded doctors. Selecting students only on the basis of their stellar grades might come at the cost of interpersonal skills and bedside manner, potentially causing worse outcomes for patients overall.

These high admission standards take their toll on aspiring doctors as well, leading directly to another harmful aspect of pre-med culture: Glorifying burnout. It can be hard not to feel guilty for taking a night off, especially when your GPA can determine so much about your future.

El Khoury wishes she made more time for friends during her time in undergrad, instead of constantly excusing herself to study.

“Looking back, I realize that I didn’t make as many friends as I wanted to because I was focussed so much on school,” El Khoury said. “If people were going out, I would say ‘I can’t, because I have to study.’”

While student burnout is not unique to McGill, the university’s lack of resources for students who intend to study medicine can leave them adrift. While advisors in the Faculty of Science can offer advice for pre-med students, their expertise in pre-med is poorly advertised. Instead, students turn to online spaces, such as the r/premed subreddit, which do not necessarily have the most accurate advice. One helpful resource the university does have is Medical Direction (MD), a completely student-run pre-medical society that supports students interested in medical professions. While the university does have a one-year pre-med program for incoming CEGEP students, it is only available to Quebec students.

Shreya Mahasenan, the program director for Medical Direction, admitted to falling into the trap of endless online resources, such as the over-abundance of information available at the nonprofit Student Doctor Network. In Mahasenan’s opinion, these sites promote an unsustainable lifestyle that usually produces burnout. One article she recalls reading during her first year boasted that no successful pre-med would stop studying to go out on a Friday night, while another suggested that anyone who performed poorly in a first-year class was “barely smart enough to be in school, let alone be a doctor."

“You get a couple of years in and you realize a lot of the burnout you have could have been avoided by simply not making yourself grind on a Friday night,” Mahasenan said.

After struggling to find the right information, Mahasenan ended up turning toward Medical Direction in search of other students to share experiences with.

“I would very much say that Medical Direction is students helping students,” Mahasenan said. “I think that’s what united a lot of people in the executive body [of Medical Direction]. We were those people who thought it was odd that there weren’t a lot of pre-med services or resources on campus.”

In many schools in the United States, such as UC Berkeley and the University of Texas at Austin, there are specific advisors that help guide pre-med students through the process of obtaining prerequisites and applying to medical school. Having resources like this at McGill—and advertising them to students explicitly—could help pre-med students feel less isolated and less inclined to turn toward those harmful online rabbit holes.

The lack of resources can make the journey into medicine even harder for those facing financial stress or other barriers, visible or not. Basing acceptance off students’ standardized tests like the MCAT can give those with more money and resources an unfair advantage. It’s far easier to do well on the MCAT when you have enough money to afford expensive prep resources and enough time to undergo hours of tutoring. By putting a lot of weight on the MCAT for medical school admissions, schools often end up rewarding wealthy, predominantly white students.

Moreover, applying to medicine in and of itself, Mahasenan noted, is expensive. Racial diversity can compound this factor: One study at UCLA found that there is significant implicit racial bias in medical school admissions.

“Medicine is not always the most equitable field in terms of access, and people run into so many associated costs that come with paying for the MCAT or paying for applications,” Mahasenan said.

In an attempt to bridge the gap, Medical Direction provides resources to students who have to work extra hard to get to the same place as more privileged students. The club offers upwards of $1500 in bursary awards and other support for students.

No matter where one falls on the income spectrum, however, achievement has costs beyond the financial. Pre-med culture is the perfect recipe for poor mental health, with gruelling competition often leading to insecurity and imposter syndrome, where you doubt your abilities and grapple with feelings of fraud.

A study by the Department of Psychiatry at the University of California, San Diego discovered a greater prevalence and severity of major depressive disorder (MDD) among pre-medical students, particularly female and Hispanic students. This finding, on top of the fact that almost 50 per cent of university-age students in Montreal report anxiety and depression symptoms, paints an extremely alarming picture.

El Khoury said she noticed her mental health deteriorate once she began to apply to medical and dental schools.

“I started having mental health problems during the end of undergrad when it was time to apply to all these schools because it was very stressful,” El Khoury said. “I was in the [mindset] where I thought that I didn’t deserve to get in because you hear about all these stories of people with [a] 4.0 [GPA] that don’t get in. So I was unnecessarily hard on myself.”

Given the sheer number of pre-med students at McGill, there need to be more mental health resources that are better publicized and easier to access than the current avenues available. As it is, students can seek help at the Student Wellness Hub and keep.meSAFE. Initiatives such as FRezCa, which offer one-on-one help for large prerequisite classes, may help first-year pre-med students feel less lost and alone.

A good starting place for solving these issues could be in the actual classroom. In fact, some professors are already trying to change their students’ mindsets. Laura Pavelka, a faculty lecturer in the Department of Chemistry, has found that her students often hold themselves to unduly high standards. Pavelka also notices that students with the goal of medical school are particularly stressed and anxious.

“Part of that anxiety stems from the idea that anything but a 4.0 is failure,” Pavelka wrote in an email to the Tribune. “I find this extremely upsetting on many levels, as practicing doctors need so much more than strong academics. This drive for academic success can be at a detriment to many interpersonal skills and empathetic personality traits.”

The pressure also stems from high-stakes testing, which is common practice among science classes. Pavelka believes that professors should instead try to model what students will be expected to do in the workforce.

“When so much rides on one assessment, it is inevitably going to lead to a hyper-competitive and high anxiety situation for all students,” Pavelka said. “Outside of a university class structure, learning is much more self-directed, collaborative, and low-stakes.”

Most of all, Pavelka emphasized that it can be unrealistic to know what your future holds at the age of 17 or 18. I identify with her words immensely. As someone who changes my mind every few weeks about what I want to do for a living, it is important to remember that changing your dream does not mean you failed—it just means you have grown. For many, giving up the pre-medical path is the right choice. As for those who stay, it is important to advocate for yourself and your own mental wellness. After all, for a system ostensibly focussed on health, the well-being of students in pre-med and medical programs is a shockingly low priority.

Illustrations by Jinny Moon, Design Editor