Success and the ILP Experience @ Trinity school of medicine

Sarah is a Trinity student wrapping up her clinical rotations and headed into the match. Her early story is common of premed students (although she, herself, is exceptional, as you'll soon learn). She has a BS in biology from the University of Illinois and boasted a strong GPA. She had significant and diverse clinical volunteer experience coming into the application cycle, and picked up a number of incredibly inspirational stories about patient interactions that deepened her commitment to medicine. In the middle of all of that, she worked full-time at a neurologist's office and volunteered as a teaching assistant in EMT certification. 

She came to Trinity for a couple of reasons, initially interested in our small class approach, as she does her best with conceptual learning in small group discussion. Our curriculum's opportunity for just that obviously appealed to her. She also ended up our way because her MCAT was, in her own words, "Not great, not really competitive." 

We have spoken, time and again, about the inflated competitiveness of US medical school admissions and their over-reliance on the MCAT exam, how the MCAT is not an effective predictor of success in medical school. Sarah is a great example of that. 

Sarah was admitted to Trinity School of Medicine's MD program on the Individualized Learning Plan (ILP) track. For those who don't know, the ILP program is a reorganization of the early basic sciences that "ramps" the course work up to the standard track's load at the start of term three. ILP students aren't separate in any regard other than scheduling, and given the small size of Trinity's student body, the only real noticeable difference from a social aspect is that they are in St. Vincent for one additional term. Trinity's tuition is also pro-rated for these students. There is no additional tuition cost for ILP students, even though they are on the island for an additional 10 weeks. 

Back on topic: Sarah utterly thrived in Trinity's ILP track, taking that "not really competitive" MCAT score that many students feel would keep them out of medical school, and going on to score a 244 on the USMLE Step-1 exam, and a 265 on the USMLE Step-2 CK.

 Illustrated a different way, Sarah had an MCAT score that had her anxious about being admitted to medical school at all. Given an opportunity to thrive, and in an environment where she could do so on her own terms, she proved herself to be in the 93rd percentile of not just Trinity students, or Caribbean students, or IMGs in general, but the top 7% of all US and international medical students combined. 

This is important for a number of reasons. First, it should send a clear message to students of what they can accomplish in the right envornment, but it's also a major signal to residency directors. Year after year, Step-1 score is the top criteria for matching.

What follows are answers straight from Sarah. How she felt along the way, what worked for her, what didn't, and how she built success in Trinity's ILP program. 
How was the MCAT prep process for you?
I did not feel good going into the MCAT. I did a Kaplan classroom course. I was there three times a week for a couple of hours, but even still, I was very stressed. I had a lot on my plate. I had a full time job, I was attending undergrad, and had a lot of extra-curricular activities.  I do blame myself, I think my downfall was time management. I felt I knew the information, I was still very anxious, though. To this day, I still think the MCAT was the hardest exam I’ve ever taken. (USMLE) Step-1 and 2 were much easier by comparison.

What was coming to Trinity like?In my first couple of days at Trinity, before classes started, I was talking to the students, “I’m on the ILP” and they'd respond, “I’m on the normal track. Why are you on ILP?” I admit, I felt bad at first, but I quickly realized that it was much better for me. It gave me just enough time to adjust to the adventure I was on. I'm from the Midwest, it was a big change heading to the Caribbean, as well as transitioning from undergrad to medical school. Trinity's ILP gave me time to figure out exactly what I needed to do to be successful. It worked out and was a big advantage in the long run.

What was your Step-1 prep like? On your own and with Trinity?I personally started studying for the USMLE Step exams the moment I started medical school. Throughout my classes, I was compiling my own notebook to study for Step-1 in particular. When students ask me why, I would tell them the truth: it was good time management for me, and it helped me start studying way in advance of the exam. When it came time to do more formal reviews, I was very familiar with not just what we'd learned, but the way Step-1 approaches the information. It was a huge load off. ILP helped me have the time to strategize appropriately from the start and make that choice. It let my personal approach flow right into Trinity's own methods for Step-1 prep. 

Trinity’s 5th term was great. Among other things, we did an organ system a week. We reviewed what we learned in the earlier terms and preceptors from the hospital would help us continue to develop our own ability to apply everything we'd learned in a clinical context. This is crucial for Step-1. It's all about taking that foundational knowledge and not just recalling it, but understanding it. Trinity was a big help, there.

Where are you now? How do you feel looking back?
I’m in my elective rotations, and throughout I find people from other international schools, and you can always spot the Trinity students, we're much better prepared. It's blatantly obvious. The residents and attendings notice us, too. It’s definitely part Milton Cato [ed. note: the teaching hospital in St. Vincent where students start clinical immersion in week one], but I also think it’s the culture of the campus.

The students they let into Trinity seem to have a different kind of approach to learning and becoming doctors. Everyone in my class and the class above me (I interacted with different groups because of how ILP folds back into the standard curriculum), was so driven and so helpful. It was always so easy to make study groups, and if you didn’t understand something, we were all always willing to help each other out. We had each other’s back. There was competitiveness, but it was friendly. There were none of the horror stories you hear about "gunners" out to get each other to make themselves look better. It was about seeing how good we could all really be. And that really shows when we get to clinicals, I think. 

You've said the ILP was great for you, would you recommend it to other students? Any regrets?

I’d recommend the ILP for certain types of students, and not just for those who can benefit for academic reasons. That extra term is such a small part of the overall education, but it can provide such a major benefit. For me, while my less-than-competitive MCAT lead me to the ILP track, it really helped because I’d never traveled alone. I'd never lived anywhere else but my home outside Chicago. It was a major adjustment. My only real issue was it threw off my timing, a bit. My turnaround time between undergrad and going to Trinity was tight, so I'm used to a certain momentum. The way it all worked out for me, I'm going to have a few months before it's time to start my match process. Anyone can and should do the ILP, but if it's something you know early on that you're a fit for and you want to hold tight to a specific schedule, January and May are also options to start.

Again though, I enjoyed having time to learn, to adapt. I think that's why it's the "individualized" learning plan. It comes down to the individual student, and it offers you time that you can use to be at your absolute best. 

Trinity School of Medicine Alumni Spotlight: Dr. Sophie Waterman

Trinity School of Medicine has always prided itself on the strength and ambition of its students. So many future physicians come our way looking for something new; whether that's a unique learning environment built on support and a strong relationship with the faculty, a curriculum with an emphasis on clinical skills and service to patients, or just a fresh start. In this next edition of our alumni spotlight, meet Dr. Sophie Waterman, Trinity graduate and family medicine resident in British Columbia, Canada.


What brought you to medicine?I come from a medical family. My father is a neurologist, so the sciences were just a general direction for me to head in at first. I'd earned a degree in chemistry, but I also graduated at a time where Canada restricted funding for science, so I couldn’t get a job anywhere. I did some traveling, and ended up in a tiny rural town called Tofino. It's on the coast of western Canada, and I worked as a secretary in a medical office. I primarily worked with the First Nations people who were only a float plane ride away. I guess I'd already started on the path to medicine via my academic work, but it wasn't until I was with those family physicians on the west coast that it clicked for me. I was drawn to that; the value of making bridges where they wouldn’t otherwise exist, and decided to apply. 

What made you pick Trinity School of Medicine? 
By the time I’d come to the decision to go to medical school, I was older. I was 24, and Canada is pretty competitive. I thought I was a good candidate, because it was also the summer, even if I’d gotten in on my first try, I  would have been 26 when I started because the app cycle was so long. Trinity would have had me graduating much, much sooner, looked into options in the Caribbean and landed on Trinity.

My admissions interview was with Dr. Wilson (ed. note: Dr. Paula Dessauer Wilson is Trinity's senior associate dean of clinical clerkships). She has remained a strong influence on my life and has become an amazing mentor. I felt a real kinship with her.

Congratulations on Matching into British Columbia. It's one of the most competitive provinces.It's funny, Dr. Wilson is the one that actually told me that I'd matched. I'd received a notification but I hadn't checked. I was too nervous. She called me and just said, "We're going to be neighbors!" (ed. note, Dr. Wilson is based out of the Pacific Northwest of the United States, and, as noted, Dr. Waterman matched into a residency in British Columbia).

What was life like on St. Vincent?

That's a huge, huge question. It was life changing and so hard to answer. I'll try, though.

It’s a really beautiful place, and if you’re interested in tropical medicine, you’ll see things you’ll never see again. I participated in the World Pediatric Project when I was there. I advocated for myself to get more access to clinical work. This lead to my first successful diagnosis (of course, a doctor had already made the formal diagnosis, but I didn't know what it was, and I asked to work through symptoms and progression). It was rheumatic fever with a very clear, newly developed heart murmur. Nothing you see here [in the US or Canada], and if something like it does present, there’d be a group of residents ahead of you to get that same experience. I feel that put me in pretty good stead with the kind of community-based, need-based medicine I wanted to practice. 

I also have to admit, I surfed every day. It was very helpful for me. Meditative. Some days, it was just paddling, but for 8 months a year, there’s a nice, surfable wave off St. Vincent.

You went to Sierra Leone, didn't you?
Yes. I worked with The Village Medical Project for Sierra Leone. It was an elective rotation I undertook and organized myself.

The Project is the brain child of Professor Aiah Gbakima, one of the most unusual and compelling human beings on Earth. He was raised in Bunabu, a remote village in the Gorama chiefdom in Kono District of Sierra Leone. It's a part of the world that has experienced every human indecency you can imagine; it was the center of slavery, then the RUF rebel fighters under Charles Taylor, the exploitation of people and diamonds, and most recently, the Ebola outbreak in 2014. The people have been through so much. 

Aiah was raised there, and through his own intelligence and heart, he got through his early education, was sponsored to do more schooling in Freetown, and made his way to North Carolina in the US. He has two PhDs, one from Johns Hopkins. He went home again to help. With an eye for his expertise microbiology, he brought medical care to his village, his people. 

I lived with Aiah in Bunabu for 20 days, and worked long, 14-16 hour days. We provided medical care for maternity cases and under-sized development cases. A major focus of the project is also on reducing the malaria burden. It's an amazing undertaking, and a testament to consistent care and long term epidemiology. The project has operated in the same area every year for the past decade (only pausing during the Ebola outbreak due to access restrictions) and is able to chart progress. This, on its own, is valuable, but in the case of the specific work, the agility of the program allows for change based on that data if something isn’t effective. The Village Medical Project has also built up a lot of trust, which has been a long process. It's helped a population come to understand how western medicine works, and how, for example, a neighbor having more medicine isn’t better. The community has learned that it's not about resource accumulation as a metric for care, it's about need. If someone has more medicine, it means they need more, something is wrong. We've also sponsored a local woman who is a nurse practitioner, now. She runs the hospital there, and another is training up starting next year. It's incredible seeing first-hand what happens when there's little-to-no access to primary care, and then it's introduced to a population. 

We asked and Dr. Waterman agreed to let us plug the donation drive for the project. If you'd like to support Dr. Gbakima and the Village Medical Project for Sierra Leone, you can click the button below. It's registered in both the US and Canada and is tax deductible. 
DONATEBack on Trinity: Do you have any advice for students considering the school?

I remember deciding to go into medicine and people being discouraging, even resentful. You’re in it, and you don’t want someone to discourage you in the thick of it, so that can be hard. Keep going, though. It'll be worth it if you stay focused and do the work. Going the route I did, you have to be more sure, and that's a good place to know if you're sure or not (when discouraged). Also, figure out how you define yourself as a doctor in order to get the residency that you want. This is personal presentation, but also choosing electives, where to apply, behavior, focus, etc. Knowing what kind of doctor you want to be is up to you, you do it on your own. Ultimately, though: don’t sweat the small stuff. If things do not appear to be going to plan, they will, keep focused, keep moving. You have to go “island time” on some things. The Canadian examination and match process changes each year, so keep vigilant on that.