#21: Pass-fail grading

Many schools are moving towards a strict pass-fail grading for part or all of the lecture years of medical school, which means that your actual numerical percentage for each sequence is never seen by anyone, and can therefore never count for any kind of future job placement. This is the only criteria worth taking into account when deciding on which medical school to attend. The medical school curriculum is taught at a breakneck speed, and pass-fail grading is the only thing that will allow you to stop backstabbing your classmates and appreciate the material instead. That kid who can't shut up about the research he's doing, your annoying anatomy lab partner, and you (who stays in bed past 1 p.m. every day) are all on the same page for as long as pass-fail grading lasts. Go ahead, take that breather. For once, you're not falling behind.

While medical school will bombard your brain with a ridiculous amount of information, pass-fail grading will remind you that being able to guess 75% of the correct answers on the test is good enough to be a doctor. Since no one will ever see your scores, you might as well use the least amount of effort possible to get through the lecture years, and save that energy for improving your golf game or something.

The only downside to pass-fail grading is that medical schools are starting to use it as an excuse to not improve their curriculum. Why worry about how hard you're pushing your students, how badly classes and events are scheduled, and how poorly information is distributed, when instead you can just say that they should be able to deal with it because everything is pass-fail? Although the giving up of a competent administration for a pass-fail curriculum is more than a fair trade, it would be nice if such a trade never had to be made in the first place.

#20: Student interviews

As mentioned before, there are two kinds of individualized interviews: faculty interviews and student interviews. While faculty interviews are clearly the more important of the two, student interviews should not be completely overlooked. They will not make or break you, but they may help to give you a little push over other, more socially inept applicants. While both types of interviews will basically be run in the same manner, there are a few important differences to be aware of.

First of all, unlike faculty interviewers, student interviewers actually want to be at the interview, and probably won't do things like looking at their watch while conducting the interview. They actually believe they are making a difference, so they enjoy the opportunity to be there. Use this to your advantage. Know that they tend to recommend accepting those interviewees with whom they connect with most, rather than those who are most qualified. Your goal should be to move past the "acquaintance" stage and directly into the "close friend" stage with your student interviewer. Feel out your interviewer's personality, and pander to it copiously. Med schools generally pick the same types of people for their student interviewers, so you should have no problem with this after the first few rounds.

Student interviewers are also much more idealistic than their faculty counterparts. This means that you need to act as if becoming a doctor is the greatest profession on God's green earth, rather than just one of many equally good options. A good way to handle this situation is to specifically mention a few of the negative aspects of the medical profession that you have heard about, and then immediately proceed to downplay and poo-poo them. This will prove to your interviewers that you are just as idealistic as they are and are therefore worthy to enter their medical school. Nothing will boost your value in their eyes more than having unrealistic expectations about what your life as a doctor will be like.

Student interviews are also your opportunity to find out about the more "fun" aspects of medical school, which is really just another opportunity to make student interviewers feel that you will fit in well in their school. Make sure to ask a lot of questions that center around student happiness and well-being, such as:

• What kinds of things do you do students here do for fun?
• What is the hardest aspect of this school?
• What made you decide to come to this school?
• How does this school compare to others, in terms of curriculum structure, administrative involvement, and overall student happiness?
• What are a few things that you would change about your school, if you could?

Remember that asking questions is nothing more than another way to impress your interviewers! Not having questions to ask is not a sign of strength; it is a sign of unpreparedness. Do not make the mistake of thinking that the answers to your questions are relevant in any sense of the word.

#19: Rankings

Medical schools have a love-hate relationship with the U.S. News & World Report rankings. On the one hand, they will tell applying students that rankings don't matter, in order to get the applicants to consider the school over more highly ranked schools. On the other hand, if any department of the medical institution gets ranked well in that magazine, you can be sure that they will shove it in your face and never let you forget it. Going to one of U.S. News's Top Hospitals is like walking into an advertisement for the hospital itself; you will see posters up everywhere telling you how awesome they are, as if that knowledge is somehow going to improve the quality of care that you receive.

Medical school rankings are important to some people (like Asian parents), but it is true that they don't really matter in the grand scheme of things. For example, the reason that U.S. News & World Report always ranks Harvard Medical School and Johns Hopkins School of Medicine so highly is because people are always going to be impressed if you attend medical school there. The people at U.S. News & World Report like to state different factors that they "took into consideration" when ranking schools, but overall the statement of these factors is just their attempt at justifying their own bias in school placement. The placement of any school after Harvard and Johns Hopkins is irrelevant, because in the eyes of residency directors, all these other "good" schools are completely equal to each other.

If you are ever told by a school official how well their school placed on the latest rankings, be sure to ask a lot of questions about how the rankings were derived. Ask for a lot of specifics, such as how much improvement there was in the factor of alumni donations from the previous year. Asking for this kind of detailed information allows you to seem like you possess a wealth of knowledge about the process, which will easily fool most administration officials.

#18: Small groups

As previously mentioned, small group is a problem-based learning environment within the larger framework of the school curriculum. The entire med class will be broken up into these different small groups, so you'll only be working with about ten other classmates of yours. Small group is generally agreed upon to be worthless, for a number of reasons. For one thing, the issues dealt with in small groups are rarely if ever related to the material in lecture. They deal more with the touchy-feely aspects of medical care, like people's opinions on stuff. Since other people's opinions are just as ill-informed and self-serving as your own, there is no way that being forced to hear these opinions will ever benefit you in any way.

However, this in itself would not be a bad thing; in fact, if done properly, it would be a welcome break from the rigors of medical school. The real problem with small group is that the questions you are given to deal with are just plain irrelevant. They are not related to the material you cover in lecture, and they will not improve your abilities as a physician. For example, many of the questions will ask you to look up statistics for prevalences of different diseases, which are completely unrelated to the presentation and treatment of the disease. You will also be asked to look up random health code policies, which won't have any significance to you until you finally get your medical degree and start practicing medicine.

For these reasons, remember not to waste too much time preparing for these sessions; there is always an easy way to fulfill your obligations for any given session. For example, if you are asked to design an interactive project to present information about Munchausen Syndrome by Proxy to the other group members, all you have to do is find a clip of the funeral scene from The Sixth Sense on YouTube, and then have your classmates discuss afterwards. Spending any more than 10 minutes preparing for a given small group session is a complete waste of energy, and a sign that you should work on your time management.

As with anatomy lab, it is quite likely that you will find yourself in a small group with an overly ambitious classmate. Identify who these people are early, then make sure to be the one to delegate tasks whenever you are assigned to work with them. This will require some cognizance on your part, but it will be well worth it if you can keep interactions with them to a minimum. Be sure to be as agreeable as possible in your messages! Nothing gets small group instructors involved more quickly than a few of their students in a heated email exchange.

#17: Taking time off after college

As mentioned previously, there are a few things you should try to put into your application to get med schools to take you seriously, all of which require an obscene amount of work through the first three years of college. If you're close to the end of college and you don't have anything to show for yourself (or if you're close to the beginning of college and don't plan on having anything to show for yourself), you will need to take time off after you graduate and do something drastic to improve your chances of getting accepted. There are a few prescribed things you should stick to when taking time off, because even though there are a lot of ways to spend time off between college and medical school, there are very few that selection committees consider to be "acceptable."

Medical schools will definitely respect time used to do research in a lab, especially if you get published. This is basically the same as doing research during the school year, except that it's more like a nine-to-five job and a lot more is expected of you. Because of both of these reasons, it makes it a lot more difficult to dick around while doing research for a full year. You'll also want to find some kind of grant to fund your time off, like a Fulbright scholarship: don't count on your parents wasting any more money on you just because you couldn't keep up with the rest of your classmates. Finally, make sure to make sure to get a good supply of crystal meth or some other strong stimulants, since research is boring as all hell and it's going to take something stronger than your typical cup of coffee to keep you awake.

Doing volunteer work is another option. There are lots of opportunities in this area, many of which are well advertised. For example, Teach for America enjoys sending out spam emails to college campuses in the hopes of reaching that one person on the planet who hasn't heard of them yet. They'll even go ahead and set up an appointment for you to meet with their recruiters without your consent, so you literally just have to show up in order to get a spot with them. There are also volunteer opportunities that allow people to practice bare-bones medicine in very rural parts of the world, especially in Latin America. It is pretty unethical for people without any medical training whatsoever to perform medical procedures on people from other parts of the world who are too destitute to care, but it still makes selection committees go absolutely cuckoo for Cocoa Puffs when they see an applicant who has these experiences.

Other year-long activities that medical schools consider "worthwhile" include getting other graduate degrees, starting your own business, or being someone famous (e.g., the child of a senator). Note that there are certain things that are absent from this list, like improving yourself as a person, or starting a family. Medical schools consider things like these to be a gigantic waste of everybody's time, especially theirs.

Of course, if no medical school accepts you even after you've taken some time off, you may have to consider alternatives such as a Caribbean medical school or even a D.O. program. Both of these types of schools are known for having lower standards than allopathic medical schools in the United States, so they are a viable possibilities for those of you who are desperate to get into a medical school and won't take no for an answer.

#16: Lecture videos

The lecture video is definitely the greatest thing to happen to lectures in the last 1,000 years. Before, medical students would need to be physically present at lectures in order to get the information needed for any given class. Lectures would commonly start at the ungodly hour of 10 a.m., but more immoral lecturers would start class even earlier than that. Tens to twenties of med students suffered under this system, but thankfully, lecture videos have changed this entire dynamic. Now, having lectures recorded allows the students to decide exactly how late in the day they want to start watching lectures, to rewind the lecture and review pertinent information immediately, and to turn off the lecture as soon as they get sick of listening to lecturers babble on about nothingness. Basically, it takes control away from the lecturers and puts it into the hands of the medical students, and lets them schedule their lecture-watching around more important things like eating and watching baseball.

One of the best things about lecture videos is that you can skip right past any nonsense that might happen in class, something that the poor suckers who actually attend won't be able to do. For example, if a fire alarm goes off (surprisingly common) or if a lecturer goes into a story that has nothing to do with the subject at hand (unsurprisingly common), you can fast-forward right past it. It's really too bad that life doesn't come with this kind of functionality, because your time is too precious for that kind of garbage.

However, the greatest benefit by far that lecture videos have over actually attending lecture is the ability to use add-ons like 2xAV to watch the videos at faster than normal speeds without chipmunk voices, as if all the benefits noted above already weren't enough. 2xAV allows users to watch RealPlayer videos at up to 2.5 times normal speed, which means that a 50 minute lecture can be watched in 20 minutes. While you might be afraid that you won't be retaining all the information when you watch it this quickly, just know that everyone else in your class is watching it at this speed. Remember that it's more important to fit in with your peers than to learn things properly.

Really the only improvement that needs to be made is to expand lecture videos to all parts of the medical school curriculum. Anatomy, for example, would be a much more pleasant experience if you didn't have to actually ever be in a dank, malodorous anatomy lab. Even events like Orientation or Commencement could benefit from being fast-forwarded through - or skipped altogether! Unfortunately, medical school administrations will never let this happen, but it's nice to dream of what could have been.

#15: Recommendations

A recommendation letter can make or break your med school application. A sparkling letter is equivalent to applying as a fifth generation legacy, so you should make sure to get as many as possible (stealing them from other students if necessary). Obviously the easiest way to secure these is to sleep with your professors, but generally speaking, the more mature or more female a professor is, the less likely they are to entertain this possibility. (Note that this is not true if you are in middle school.)

A more realistic way to get a good recommendation letter from a professor is to take a lot of classes with them, like more than five. Make sure to be that annoying kid who asks lots of questions during lecture and needlessly prolongs class for everyone else. It's a surefire way to guarantee that your professor - and everyone else - will never be able to forget you. If you can manage to do this for more than one professor, you should have no problem getting the recommendations you require. You will also be universally loathed by your classmates, which is a small price to pay for something so important.

If you have trouble burying your self-consciousness long enough to enact the previously mentioned tactic, you will need to take more subtle routes to remind your professor of how awesome of a student you were. One thing to do is to make a packet for your professors that has all the information they need in order to write the recommendation. Make sure to include a cover letter, a transcript with your best classes prominently highlighted, and a gift card to their favorite restaurant or department store. Feel free to blatantly lie about your accomplishments in your cover letter; as professors have to deal with upwards of 100 students per semester, it is highly unlikely that they will know anything about you. Finally, people often say to write professors a thank you letter once you've been accepted to a school, but this is entirely unnecessary; since you'll never see these professors again, you are under no obligation to pretend to care about what they think of you any longer.

If you can help it, try to get actual copies of the recommendation letters to see what they say about you. This can be easily accomplished by renting a P.O. Box from the post office for a fake program (e.g., "Tidewater University Summer Scholars Program"), and having your professor send in a recommendation to that P.O. Box for you. This course of action has many benefits, the most obvious of which is that you will be able to find out exactly what your professors will write about you. With this knowledge, you will now have the power to prevent them from backstabbing you in the future.

#14: Medical television shows

Medical students love shows that are set in a medical environment. Grey's Anatomy, House M.D., Scrubs, Nip/Tuck, Doctor Who - the list goes on. Med students swallow them up like Skittles. In fact, it has been documented that fully 75% of the increase in medical school applications over the past three years is directly attributable to the surge in popularity of these shows. If you're new in the television business and you're desperate to create a hit show, all you need to do is take a bunch of old jokes from other hit television shows, and recycle them into the setting of a medical environment. You don't even need to worry about medical accuracy, since the majority of your intended audience will never even know if you make a mistake.

One reason that med students like these shows so much is that they get to live vicariously through them. Real doctors do silly things like take care of patients and fill out paperwork, but doctors on television shows spend most of their time making snarky comments at each other and having lots and lots of sex. Doctors on television also never have to face the consequences of their actions (unless their real-life actor does something stupid). Watching these shows gives medical students a socially acceptable way to fantasize of doing nothing all day except acting as cool as Fonzie and having unnatural amounts of sex with marginally attractive individuals.

Medical students also like these shows because they give the students a chance to show off how much they're learning in school. This does let them impress people occasionally, but mostly it lets them feel good about themselves. For example, if one of the actors mispronounces a phrase like "bilateral hyperplasia of the adrenal zona fasciculata" incorrectly, they will be mocked for no less than fifteen minutes. A really serious instance of medical incorrectness can be milked for conversation fodder for weeks at a time.

Non-med students also watch these shows, but mostly because of the hot actors and actresses (Katherine Heigl, I'm looking at you) and the ridiculous situations the actors are put into. Overall, these shows have better plot elements and character development than other typical shows like Spongebob Squarepants or Friends, so it makes sense that they've attained mainstream popularity.

#13: Problem-based learning

As previously mentioned, some schools try to buck the mold by using a teaching method called "problem-based learning." This entails having students do lots and lots of problems instead of emphasizing lectures. It was developed at a university in Canada, which explains why it sucks so hard.

Problem-based learning is touted by its proponents as being a non-traditional way of teaching, which is a surefire way of knowing that it's not quite as good as the usual method. One big drawback to problem-based learning is that doing problems over and over again becomes really tedious after about 13 seconds. However, the bigger drawback to problem-based learning is that students never actually learn the principles behind the problems that they solve. They become like little monkeys who can apply the right equation to a given problem, but have no deeper understanding than that. When it comes time to study for a national exam such as the USMLE Step 1, which asks questions requiring integration of fundamental concepts in medicine, these students are basically screwed.

Most lecture-based schools include a little bit of problem-based learning in something called "small group." Small group sucks really hard too, but it is only a taste of what problem-based schoolers go through. Every night before they sleep, lecture-based schoolers offer this prayer: "Dear God, please keep me and my family safe. And thank you for not sending me to a problem-based learning school. Amen."

#12: Pre-meds

As soon as you get into a medical school, you can expect every pre-med you have ever known to descend upon you like a hobo on a ham sandwich. They will want to know things like what your MCAT score was, what leadership experiences you have, and how many people you had to sleep with. It is flattering at first, but it quickly becomes irritating because all these people are just using you. If a long lost friend who you haven't thought about in years suddenly contacts you, make sure they are not looking for a copy of your AMCAS application before you let yourself get too excited.

Your pre-med friends will send you long emails with all sorts of information about themselves and ask you what you think their chances of getting into med school are. The best way to approach this situation is always to tell them the same thing: with a little more hard work, they would pretty much be the perfect candidate. Be wary of going into any details in your reply, because the more details you go into, the more likely they are to email you for more information. Also be sure to wait a few hours or even days before you reply so they think you actually read what they wrote. If they do email you again, just tell them that you're a little too busy right now, and ask them to email you again in a few weeks. Pre-meds have a very short attention span, and so they will likely forget that the encounter ever happened.

While it would be easy to get angry at those who contact you, remember that there was once a time when you used to do these same annoying things. Suck it up and at least give them the courtesy of a response before you go back to doing something more important.