AMCAS 2024: “Disadvantaged Applicant” Question Revised to Broader Adversity Question

The AMCAS “disadvantaged applicant” question is no more. This year’s AMCAS application has introduced a new question in its place that asks more broadly about an applicant’s “impactful experiences.” 

The 2024 AMCAS application will now include the following question and guidance: 

Other Impactful Experiences 

To provide some additional context around each individual’s application, admissions committees are interested in learning more about the challenges applicants may have overcome in life. The following question is designed to give you the opportunity to provide additional information about yourself that is not easily captured in the rest of the application. 

Please consider whether this question applies to you. Medical schools do not expect all applicants to answer “yes” to this question. This question is intended for applicants who have overcome major challenges or obstacles. Some applicants may not have experiences that are relevant to this question.  Other applicants may not feel comfortable sharing personal information in their application.  

o Yes o No 

Please use the space below to describe why you selected “yes.” [This text and the textbox only appear if “yes” is selected for this question.] 

In a pop-up box, AMCAS provides some helpful examples. It reads:

The following examples can help you decide whether you should respond “yes” to the question, and if so, what kinds of experiences you could share. Please keep in mind that this is not a fully inclusive list and any experiences you choose to write about should be ones that directly impacted your life opportunities. 

Example Experiences 

• Family background: serving as a caretaker of a family member (e.g., siblings, parent/guardian), first generation to college 

• Community setting: rural area, food scarcity, high poverty or crime rate, lack of access to regular health care (e.g., primarily used urgent care clinics or emergency room, no primary care physician) 

• Financial background: low-income family, worked to support family growing up, work-study to pay for college, federal or state financial support 

• Educational experience: limited educational opportunities, limited access to advisors or counselors who were knowledgeable/supportive of higher education requirements 

• Other general life circumstances that were beyond your control and impacted your life and/or presented barriers (e.g., religion) 

Why the change?

The AAMC made the revision in response to “limitations” identified with the previous question, which asked a candidate if they wished to identify themself as a “disadvantaged applicant.” Research into the text found that applicants found the question ambiguous, and that many had a negative reaction to the use of the term “disadvantaged applicant.” 

However, AAMC’s research also found that both applicants and admissions officers found value in the intent of the question, which was “to provide rich contextual information about an applicant’s journey and how their lived experiences align with schools’ missions and/or the communities they serve.” 

The revised question and associated guidance was piloted using the Summer Health Professions Education Program and the supplemental Electronic Residency Application Service. And both the question and guidance received “generally positive feedback” from administrators and applicants. 

Should I respond to this question?

As with the question that preceded it, this question text states that not all candidates are expected to respond. Rather, it is intended for those who have had “major challenges or obstacles.” 

That being said, this updated question provides applicants with a broader scope for responses. So, we urge you to consider any significant challenges that you have faced, using the following questions:

1. Did this experience impact my life in such a way that it provides meaningful context to my application? 

Examples of such adversity include: Facing a significant health challenge such as cancer or a disability; serving as the guardian to your younger siblings, while also attending classes (likely, negatively impacting your resume); living in an underserved medical community that made it difficult to gain shadowing or clinical experiences, but also inspired your interest in rural medicine. 

Alternatively, more typical experiences that likely do not represent significant adversity (but potentially belong in your personal statement or secondary essays) include: Breaking a bone during high school athletics and going through a difficult recuperation process; facing a life-impacting food allergy, the dissolution of a romantic relationship, a domestic move, and/or your parents’ divorce. While these experiences likely impacted you greatly, they may not belong in this response. 

2. What did I learn from the experience? 

Your essay response should detail the adversity, but should center on what you learned from going through the experience. Did this experience provide you with an “ah-ha!” moment that changed your perspective and impacted your life? If the take-aways from the adversity do not feel relevant to your application (i.e., your learnings do not clearly make you a stronger candidate for a medical school), you should reconsider the take-aways or including the experience.

3. Have I already spoken to this experience in my personal statement? 

You will want to avoid redundancy by sharing different stories and anecdotes in this essay and your personal statement. If you fully explored the experience in your personal statement, do not feel compelled to re-write about the experience here. Not all applicants are expected to have responses to this question. 

Your writing approach:

Overcoming adversity makes for a stronger medical school candidate and this is what you will want to emphasize in your response: Provide the reader background on the situation in the first 20 percent of the response. But the remaining 80 percent should be devoted to what you learned from the adversity.

How will your future classmates and patients benefit from the lessons you gained from the adversity? Keep in mind the qualities that medical schools are looking for in prospective students and show the reader how your experience improved your dedication to medicine and resilience and/or your abilities in leadership, teamwork, empathy, and critical and creative thinking.

AAMC’s President and CEO Addresses Top Challenges Facing Academic Medicine

Last weekend, the President and CEO of the American Association of Medical Colleges (AAMC), David Skorton, MD, addressed over 4,200 leaders in academic medicine on the “four things that keep me up at night.” These include structural and cultural inequities in academic medicine, deteriorating student wellbeing, external threats to the doctor-patient relationship, and a lack of mutual respect. On these challenges, Skorton called for collective action. “The health and mental well-being of our communities and our colleagues are at stake. Through meaningful, open, and honest dialogue, partnership, and collective action, we can and will tackle these problems in service of the greater public good,” he said. Below, we summarize his concerns. 

Diversity, equity, and inclusion and anti-racism. Within academic medicine, Skorton noted that this work includes diversifying medical schools’ student populations, faculty, and staff. It also goes further. Each academic institution should review their culture to ensure that the climate supports every student with the “opportunity to excel.” 

Student well-being and mental health. Skorton notes that medical students show higher rates of depression and risk of suicide than their age-matched peer populations, and that the comparisons have worsened in recent years. He encouraged academic leaders to prioritize the mental health and wellbeing of students by understanding their existing stressors (financial, academic, and social) and reducing them, as possible. Medical school faculty and staff should also ensure that they make mental health and wellbeing resources accessible to students. 

External threats to the doctor-patient relationship. While not speaking to abortion rights specifically, Skorton spoke to the more generalized threat that legislation and/or judicial opinions can impose on a physician’s ability to exercise clinical judgment in partnership with the patient. He encouraged leaders to “stand firm” against such external action in order to protect the doctor-patient relationship.

Humility and mutual respect. While Skorton emphatically noted that physicians are duty-bound to speak out against racism or hate speech, he called for greater mutual respect. He noted that leaders in academic medicine should show humility in their interactions and discourse, and called for physicians to model using an open-mind and empathy in encounters with those holding differing viewpoints or conflicting ideologies. 

Post-MCAT Survey Shows Prospective Medical Students are Increasingly Interested in Schools that Provide Academic and Social Support

Earlier this year the AAMC released its 2020 Post-MCAT Survey results. This survey, administered annually, provides insight into the individuals who take the MCAT—their backgrounds, preparation strategies, career plans, and interests. In 2020, 39.2 percent of test-takers responded to the online survey, which equates to over 30,000 people. The survey is provided after the MCAT is submitted, but prior to the test-taker receiving results. This year’s findings show slight, but persistent shifts in the socioeconomic background of MCAT test-takers, an increased interest in the academic and social support provided by medical schools, and growing concern about the cost of applying to and attending medical school. 

Below, we provide selected findings from the latest survey:

Premedical Life and Experiences

To gauge socioeconomic status, the AAMC uses the Education Occupation (EO) indicator, which classifies test-takers as EO-1 through EO-5 based on a parent’s highest educational level and occupation. Every year since 2016, the largest proportions of MCAT test-takers have come from those categorized as EO-5 (a parent obtained a doctoral degree and/or is employed in an executive, managerial, or professional occupation) and EO-1 (a parent obtained less than a college degree and/or is employed in any occupation) at 25.4 percent and 24.1 percent, respectively. It is important to note, however, that the percentage of MCAT test-takers classified EO-1 has declined slightly each year since 2016, with a 2.6 percentage point decline over the last five years.

Most respondents, 61.9 percent, decided that they wanted to study medicine prior to entering college. And a large number reported having spent time volunteering in a healthcare setting (84.9 percent), shadowing a physician or other healthcare professional (80.9 percent), and just over half (50.7 percent) participated in a laboratory research internship program for college students. 

More respondents graduated from college prior to taking the exam (53 percent) than not (47 percent). But this percentage has shifted annually, with the exact opposite occurring in 2016 (53 percent taking the test pre-graduation and 47 percent taking it post). Most of those who had graduated did so recently: 42 percent within the last year and 31.9 percent within the last one to two years. Just 12 percent had taken five or more years between graduation and the MCAT. About 60 percent reported taking courses at a college or university in the three months prior to the MCAT, while just over a quarter (27.6 percent) said that they had not attended school in the past three months. 

MCAT Preparation Strategies

Most respondents reported that they started their preparation by reviewing the scope of topics that the MCAT covers (81.4 percent) and assessed their progress throughout their study period using practice exams (82.4). Over three-quarters of respondents created a study plan to fit their schedule (75.2 percent), identified their strengths and weaknesses using practice exams (78.3 percent), and assessed their readiness by taking a final practice exam (78.4 percent).

In terms of the concepts, most prepared by answering practice questions while studying each topic (87.8 percent), consistently reviewing content they had previously studied throughout their preparation (82.6 percent), and testing their understanding of concepts studied (80.7 percent). Slightly fewer made sure to review each answer choice in the practice questions to determine why they were correct or incorrect (74.7 percent) and mixed in their review of different topics throughout their studying (74.9 percent).

The most used resources were the Official MCAT Practice Exams (85.4 percent) and commercially published MCAT prep books (72.6 percent). In terms of utility, 73.1 percent of those who used the Official MCAT practice exams described them as “very useful,” and 61.7 percent of those who used the Official MCAT Section Bank found it “very useful”. While just 45 percent of those who used commercially published MCAT prep books called them “very useful,” another 38.4 percent labeled them “useful.”

Almost all (89.7 percent) respondents said that they prepped for the day of the test by taking a timed, online practice test with scheduled breaks to “mimic the exam day.” A large number also practiced pacing so that they could get through all the questions in each section in a timely manner (85 percent), and most (79 percent) made sure to get plenty of sleep the night before the exam. 

When asked to name their biggest challenges in preparing for the MCAT, over two-thirds said that they struggled with maintaining confidence in their ability to succeed on the MCAT (67.6 percent) and 60 percent noted their difficulty with getting through the large amount of material they needed to learn for the test. 

Career Plans and Interests

Most respondents noted that they are “very likely” to apply to an MD-granting medical program (86.8 percent), while just under one-third said that they are “very likely” to apply to a DO-granting program (32.4 percent). Both percentages have been relatively stable since 2016. 

When asked what would encourage their application to medical school, students were most likely to select: finding a school where I will feel comfortable (88.9) and a fit between my interests and a school’s mission (83.4). However, the number of students who selected availability of academic support in medical school (71 percent) and availability of social support in medical school (63.9 percent) both increased significantly from 2016 (+7.8 percentage points, +11.5 percentage points respectively).

When test-takers were asked to describe what would discourage them from applying, most students selected grades, MCAT Scores, and other academic qualifications (72.5 percent). The number of those who selected the cost of applying to medical school (53.1 percent) and the cost of medical school (68.9 percent) as deterrents has increased by 6.5 and 6.1 percentage points respectively since 2016.

For full survey results visit https://www.aamc.org/media/51241/download

AAMC Physician Workforce Report Shows an Increasing Number of Women, Physicians Nearing Retirement, and Doctors of Osteopathic Medicine

The proportion of women within the active physician workforce continues to increase, as does the proportion of those nearing retirement age and those with a Doctor of Osteopathic Medicine (DO) degree.  Late last month the Association of American Medical Colleges (AAMC) released its 2020 Physician Specialty Report, which provides demographic and specialty trends within the active physician and resident/fellow workforces. It is important to note that the data used to populate the 2020 report was reflective of the 2019 physician workforce.

Active Physicians

In 2019, over one-third of active physicians were women (36.3 percent); this percentage has been steadily rising since 2007 when women made up just over a quarter of the workforce (28.3 percent). This growth reflects the steady increase in female medical students, with women making up the majority (50.5 percent) in medical school for the first time in 2019. The report notes, however, that women still tend to remain concentrated in specialties pertaining to women and children, including pediatrics (64.3 percent), obstetrics and gynecology (58.9 percent), and pediatric hematology/oncology (55.1 percent), and have marginal representation elsewhere. Women make up less than a quarter of the physician workforce in a great number of specialties, including various surgery sub-specialties where the number ranges from 22 percent in general surgery to just 5.8 percent in orthopedic surgery. About ten percent of physicians in pulmonary disease (12.3 percent) and urology (9.5 percent) are female. There are no specialties where male physicians make up less than 35 percent of the workforce.

Just under half of the physicians were 55 and over (44.9 percent) in 2019, which is a marginal increase from 44.1 percent in 2017 but a more significant increase from 37.6 percent in 2007. Over 50 percent of the following specialties are made up of physicians aged 55 and over: preventative medicine (69.6 percent), thoracic surgery (60.1 percent), orthopedic surgery (57.1 percent), and urology (50.5 percent). Several of the specialties which are populated with older doctors also have the highest percentages of males, and conversely several of those with the lowest percentage of older doctors are among the highest in female doctors.

Another slow-moving trend is the increase in practicing physicians with a DO degree. In 2019, 8.2 percent of physicians held the DO degree, while U.S. MDs made up 66.1 percent of the workforce and international medical degrees made up 24.7 percent. This is subtle, but real growth from 2007, when 69.5 percent of physicians held a U.S. MD, 24 percent held an international medical degree, and just 6.5 percent held a DO. In one of the fastest growing specialties, sports medicine, 18.9 percent of practicing physicians were DOs in 2019.

Residents and Fellows

Among the Residents and Fellows in 2019, 45.8 percent were women, like the 2017 figure (45.6 percent), and up slightly from 44.6 percent in 2007. As seen in the physician workforce, female residents/fellows tend to pursue the care of women and children in high percentages, with obstetrics and gynecology (83.8 percent), neonatal-perinatal medicine (74.9 percent), and pediatrics coming in at the top (72.4 percent). However, large percentages of women are also pursuing specialties in endocrinology (70.8 percent), allergy/immunology (68.2 percent), and geriatrics (67.8 percent).

Just as the percentage of DO graduates increased within the active physician workforce, it was also more prominent within the resident/fellow population. In 2019, 15.7 percent of the resident/fellow workforce had a DO degree, an increase from 12.5 percent in 2017 and 6.4 percent in 2007. The percentage of U.S. MDs showed a relative decline over the same period, with 61.1 percent of the 2019 population compared to 65.9 percent in 2007; similarly, international medical school graduates declined from 27.4 percent of the resident/fellow population in 2007 to 23.1 percent in 2019.

Medical School Enrollment Growth Limited by Space Constraints in Clinical Training and Residency Programs

Last month, MedPage Today reported that applications to medical school have risen significantly compared to the same period last year, according to both the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM). AAMC reported a year-over-year increase of 14 percent in early August, and AACOM reported an uptick of 17.7 percent as of mid-August.

Sources speaking to MedPage Today pointed to the pandemic as a reason for the spike, suggesting that the current high-profile nature of medical personnel may be inspiring applications to medical school. Other applicants may be taking advantage of idle time to submit their applications early, while some may be seeking alternative paths to mitigate economic uncertainty. Geoffrey Young, AAMC’s Senior Director of Student Affairs and Programs, told MedPage that the early indicators may not necessarily indicate a more competitive year, noting that the pandemic has created “an unconventional time.”

While both AAMC and AACOM schools are expanding their capacity where possible, both note that their growth is limited due to a lack of corresponding residency spots. The AAMC has launched a few new schools, which has increased overall enrollment, and remains optimistic that many schools will be able to make incremental increases in class size. Larger updates to class sizes, however, would have to be approved by the accrediting agency. Osteopathic school enrollments are growing faster, with a 6.6 percent increase approved for the upcoming year by the accrediting agency, up from a 5.6 percent increase the year before.

This capacity constraint suggests that many qualified candidates may not find a place in medical school, despite a national need to grow the physician workforce. Results released last week from the AAMC Annual Survey also focus on the significance of the clinical experience constraint. In the survey, which was administered in November 2019 to 154 medical schools, school leaders voiced apprehension about the number of residency positions and clinical training sites available to students.

Just under half of the schools reported “major or moderate” concern about their students finding post-graduate residency positions of their choice. While medical school enrollment has seen significant growth over the last two decades, an increase of 33 percent since 2002, residency availability has grown much more slowly. Federal support for Graduate Medical Education (GME) provided through Medicaid, has been capped for the last two decades, effectively leaving funding for GME at teaching hospitals at 1996 levels. The National Resident Matching Program reports that this year 40,084 MD and DO graduates applied for only 37,256 residency positions though the Main Residency Match.

In addition to concerns about residency, a large majority of medical school leaders reported concern over the availability of clinical training sites for students. As demand increases for clinical experiences from other medical trainees, including nurse practitioners, physician assistants, and DO programs, AAMC medical schools are feeling more stretched to meet their students’ needs. Most of the survey respondents reported concern about clinical training sites and qualified primary care preceptors, 84 and 86 percent respectively, and just under three-fourths, 71 percent, mentioned concern about students having access to qualified specialty preceptors.

Early MCAT Registration Numbers Show Significant Interest in Medical School

The AAMC announced a positive outlook for future medical school classes. When the MCAT registration opened in early May, after having been closed in March and April due to stay-at-home orders, 62,000 people registered online. This is a significant increase from the typical 10,000 to 12,000 on the opening day of registration. Similarly, registration for the American Medical College Application Service in early March showed an increase of 50 percent (in the number of applications started in the same period last year) in the first three days. While not all these prospective students will submit applications, it does provide reason for optimism about the future.

President and CEO of the AAMC, David Skorton, MD, said, "We're very encouraged by students' strong interest in registering for the MCAT exam. We're starting to see hints of strong interest in people entering the field overall, even though it's quite early in the medical school application process. It is a great sign if this preliminary trend continues, because our country needs more doctors."

Medical Schools Plan to Resume Clinical Learning Experiences

In May, the AAMC provided an update on medical schools’ plans to resume operations.

For medical students working in clinical care, most schools plan to resume work this summer.  As of early May, 103 of 155 total schools had reported their plans to the AAMC; 15 percent planned to restore students’ clinical care work by the end of May, 55 percent (cumulative) by the end of June, and 77 percent (cumulative) by the end of July. An additional 15 percent were still finalizing plans.

The AAMC noted the delicate balance necessary for returning students to clinical care. Patient safety and containing COVID-19 must be parallel goals alongside allowing students access to the patient-centered learning hours they need for a timely graduation. Medical schools are also struggling to create meaningful learning opportunities due to the diminished capacity of many supervising physicians to teach and the fact that routine surgeries and visits have been limited or restricted.

According to an article published in Crain’s Health Care Forum over the weekend, during this period, many schools have front-loaded virtual course work. The article also mentioned that some schools, such as the Cleveland Clinic Lerner College of Medicine, were able to allow students’ access to patients using virtual clinics and virtual hospital rotations.

As many students prepare to return to clinical care, obstacles will remain. Many schools and hospitals are not going to allow students to work directly with confirmed or suspected COVID-19 patients and some hospitals are limiting the number of people who can enter a patient’s room simultaneously. This suggests that training will continue to require creativity and a dependence on technology, with schools working with state boards and accrediting bodies to determine what will be approved.