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Show biology, chemistry, physics, and calculus, combined with English and some social science. The science classes are typically "weed-out" courses, designed less to actually teach science or help students develop a desire to learn more about the field, than to discourage them from going further, and often specifically to discourage them from applying to medical school. Those who survive these hazing experiences and get within striking range of a degree then take the Medical College Admissions Test (MCAT), a standardized test designed to measure preparation for a medical degree. MCAT score and GPA are the two objective items in a prospective medical student's application, and are widely believed to be determining factors in a medical school's decision-making process. The remainder of the application consists of a personal statement ("why I want to be a doctor when I grow up") and letters of recommendation. The medical school evaluates the application, based on either objective criteria (for instance, the University of Texas at San Antonio uses a formula including the applicant's age, MCAT scores, and GPA to rank all its applicants) or subjective assessment, and decides which of the applicants to interview. The applicant typically interviews with four to six faculty members, each of whom assesses the applicant and provides a rating or score. The admissions committee then meets and decides on categories for each applicant, usually "must admit," "must reject," "would do OK," and "would do if we're in a bind." The committee then sends letters of acceptance or rejection based on these decisions. Since most applicants have applied to multiple schools, the school then waits to hear whether the applicant accepts or rejects their offer. If it is rejected, an admission letter is sent to the next person on the list, until all the slots for the incoming class are filled. Admissions letters are sent out from January to the start of classes, and applicants gain or lose self-esteem based on the timing of their acceptance letter. Once the student has surmounted the hurdles of the pre-medical years, it is time for the hurdles of medical school. Unlike the undergraduate years, where students could select courses and schedules that suited their preferences, medical schools generally adopt a lock-step curriculum with few options. Days are filled with lectures or laboratory work, and huge amounts of reading and homework are assigned. The student typically spends from 8 a.m. to 5 p.m. at the medical school in lecture or lab, and is expected to spend a similar amount of time studying outside class. Students are filled with guilt, feeling that if they fail to master every little detail they may be responsible for a patient's death. Examinations are almost exclusively multiple-choice format and require detailed knowledge to be able to complete successfully. Since the multiple-choice format is generally National Board-style (4 answers, #1-4 are shown; answer options are A (1,2, and 3 are true), B (1 and 3 are true), C (2 and 4 are true), or D (only 4 is true)) the student must know whether each of the items is true or false, rather than simply picking the one best option. The first two years are filled with this style of learning, with little exposure to either patients or diseases. During a World Health Organization (WHO) conference on medical education and primary health care, one participant described current medical school curricula as involving "outdated teaching methods, which impose on the student the memorization of fragments of information, but which do not help him to acquire the critical and independent habits of thought necessary for identifying and solving problems, or to develop the motivation and habit of continuing self-learning." (Midtling, Barnett, Blossom, & Barnett, 1990). By the third year, which is the major clinical year, the students are bursting with desire to actually see a patient and find out the relevance (if any) of the information they have so painfully accumulated over the last two years. The third year is completely different from the previous two. The student is now working in the hospital, with few lectures and no laboratory time. For the first time, and with little knowledge of what he is doing, 92 PHYSICIAN SOCIALIZATION |