Super Star Blogs!

Congratulations to Rafeal! Premed of the Week!

1. Tell us a little bit about yourself.  I am from Brunswick, Georgia. I grew up playing football and basketball. I am a fun, outgoing person that really enjoys giving back to the community.

2. Who was your favorite teacher in school and how did he or she impact you? My favorite teacher was my high school anatomy professor, Mr. Hall. He saw the potential in me and always motivated and encouraged me to be the best person that I can be. I had a lot of personal issues and he was always someone I could trust and confide in when I needed someone to talk to. He took me to visit colleges and I actually attended the same college that he went to because of his influence on my life. He is a great man, and even now we stay in contact. He has been a blessing to me, and I am blessed to meet a man like him.

3. When did you first decide you wanted to become a doctor and why? I decided I wanted to become a doctor around the age of 8 or 9. I am from a small rural and underserved community that is plagued alcoholism, HIV/AIDS, homelessness, and many other health disparities. I chose medicine because I wanted to have a positive impact on the health problems in communities around the world and to provide health care to those who would not normally have access. Also, around that time my aunt died from HIV/AIDS so it gave me a stronger drive to want to make a difference through medicine.

4. What area of medicine are you interested in? Medicine as a whole is very interesting. In general, I am interested in being in the OR, so I am leaning towards the surgical aspect of medicine and practicing in underserved communities.

5. What’s the coolest experience you’ve had so far on your premedical journey?  The coolest experience I have had so far in my journey has to be performing clinical research at NIH for two years. Being able to get an in-depth understanding of how to do clinical research and provide excellent patient care has been amazing. Working with African immigrants day in and day out has really given me a greater appreciation of the many difference between people but also showed me how building an interpersonal relationship with your patients is key to establishing trust which is essential in medicine.

6. What is your favorite book?  My favorite book is called, Always Outnumbered, Always Outgunned by Walter Mosley. I read it my sophomore year in college at Morehouse. This book connected with me on so many different levels and taught that no matter what happened in your past, you can change and have a positive impact on the present and the future for those around you.

7. Tell us one thing interesting about you that most people don’t know. One thing about me that most people don’t know is that I am the oldest of 9 siblings and I am a really strong chess player.

Top 10 Pre-Medical Vloggers

Premedical Vlogging is on the rise, and everybody’s got their own show now!  While there are tons of great vloggers out there, these are our top 10 premed and medical school vlogging channels for summer 2017!  **Note, the number of video views and subscribers contributed greatly to this rank list order.

Honorable mention goes to Imperfectly Me. Dr. Jay.  Dr. Jay,  has made an impressive sprint in the premed/medical vlogger community. As she puts it, she is mentoring via sharing her incredible journey into medicine.  In a few short months, her engaging personality grew her channel to over 8,000 subscribers.  It’s likely that she had a busy intern year of residency since her uploads haven’t been as consistent lately.  But once Dr. Jay gets back on schedule, she’ll take the vlogging community by storm.

Number 10:  We’re starting with a tie.  JustOsaro & thebrittnyway

JustOsaro.  You’ve gotta love Osaro’s passion for mentorship.  While there are a couple of vloggers not on this list who have more subscribers that she has, Osaro inches past them for two reasons.  First of all, she’s generous with her resources and provides downloadable information for free to her subscribers, and second she has more total video views.  What we love most about Osaro is that she is relatable and has a genuine personality suitable for her viewers.

thebrittnyway for this 10th position.  Brittny is a medical fashion diva who provides amazing video content.  Simply check out her channel and you’ll notice that for the number of subscribers she has, there is a disproportionally high number of video views.  And while some of her top videos pertain to fashion, Brittny’s medical videos carry their own weight as well!

Number 9: EJ_Fitness.  If you’re looking for the most fit medical student in the U.S., EJ might be your guy.  His unfair abs advantage probably earned him some extra views from the ladies.  EJ gets special kudos for showing others that you can still excel in your passions while performing well in medical school.

Number 8: America.  Not the country, the person.  If you’ve been paying any attention at all, then you know America is gaining ground quickly.  It’s likely a few “lifestyle” vlogs have won her some non-medical followers, but since she recently starting her medical vlogs, America has become a YouTube star.  With approximately 10,000 subscribers, she already has over half a million total video views.

Number 7:  Student Doctor Thompson.  This husband and father is a veteran premed/medical school vlogger.  His videos are definitely some of the cleanest in appearance and audio.   Student Doctor Thompson gets a special kudos for his thoughtful approach to video content.  He also has several cameo appearances with his wife which provides an extra element of life outside of medical school.   In all honesty, he would have had a much higher position on our rank list if he was still publishing content consistently.  But even without doing that, he remains one of the best ever premed/medical school vloggers to date.

Number 6: Jenny Le.  Jenny keeps it real!  Her vlogs touch on the real life issues and not just medical school.  From debt, to pregnancy, to depression, jenny hits it all.  We’re giving Jenny extra kudos for her longboarding skills too!  Currently, she has 33,000 subscribers and over 1.2 million views!

Number 5: Jane and Jady.  Yep that’s right. you’re getting two for the price of one!  At 64,000 YouTube followers, they’ve definitely got something special going on. Jane and Jady give viewers a special peek into the life of a medical school couple.   From cars to fashion, they’ll show you how they live.

Number 4: Andrea Tooley.  Dr. Tooley, is a legend in the premed/med school vlogging community.  She’s been around for some time and has a very engaging community of subscribers.  What sets her apart from other vloggers is her cherry personality which makes everyone feel like her friend.  Also, Dr. Tooley features guests vloggers which allows her viewers to gain even more value from her channel than they can from only one individual.

Number 3: DocOssareh.  While he isn’t quite as consistent in posting vlogs as he used to be,   you’ve got to  give him credit as he continues to rack up views.  That speaks to how excellent his content!  Also, from what we can tell (and from what he claims as well), he is “YouTube’s Original Pre-Med and Med School Channel”.  So, giving credit where it’s due, shout out to the originator!

Okay, are you ready for your final 2?  These were close!

Number 2: SabsBeauty.   Sabrina is a medical fashionista and does an amazing job of balancing her fashion videos with her medical journey.  This combination has provided her with a greater reach, giving her the largest number of subscribers among our top 10 vloggers.  We’re giving Sabrina a special shout out for giving thousands, if not millions, of women worldwide the confidence to be beautiful and intelligent.

Okay…drum roll please!

Number 1: TheStriveToFit.  Jamie inched in to grab the number one position. With over 155,000 YouTube subscribers, she’s like the mayor of her own small city.  Jamie’s videos are very well put together and have a personal touch to fit her personality.  Not only does she answer viewers questions, she actually puts clips of them in her videos!  Jamie is consistent in releasing video content and has reached as high as 315,000 views on a single video.  Well done Jamie and congrats on being this summer’s top Premed/Medical School vlogger!

A very special thank you to all of these wonderful vloggers!  Thank you for sharing your world with us.

So here is our question to you, the reader.  Who is your favorite YouTube premed/medical school vlogger?

The Humble Physician

“Remember this day! Remember this day!”

These were the words repeated by my very dear friend on the day I was accepted to medical school. She forever etched a memory in my brain. I didn’t think much of the statement at first but after the 3rd and 4th echo I obliged to this request and soaked in the moment. This was the victory lap following the blood sweat and tears I shed as a premed.

So, I remembered…

I thought back to those sleepless nights studying, those hours shadowing physicians and volunteering, the summers I spent doing research instead of traveling with my friends, and all the money I spent on applications and interviews. I deserved it! I had worked harder than everyone around me to get to this point. I was on top of the world! I received a number of congratulatory phone calls and was paraded around town with my new title, “soon to be doctor”.

And then, I remembered…

I thought back to how nervous I was before the big tests and how uncertain I was of my chances at becoming a doctor when I didn’t score as high as I wanted to on my first MCAT. I remembered the many people who picked me up when I felt like the dumbest student in class and those who mentored me along the way. I even had flashbacks to my hospital volunteer days when no doctor would take a second to speak with two premed students simply looking to shadow for the summer. We felt as though we were always in the way, and this made us believe we were worthless. At that moment, I recognized how fortunate I was to be in this point in life and I vowed to myself that day that I would not be one of “those” doctors. I would not let this doctor thing go to my head. I would be grateful every day, not look down on others, and give back to those following in my path. I would be the doctor who spoke to the shy premed just wanting to learn and not bother the almighty doctor.

The Totem Pole of Medicine

Progression in medical training can be summed up this way; just when you begin to celebrate a new achievement, you quickly realize you are back to bottom rank. The med student looks down on the premed. The resident bosses around the med students. The fellow laughs at the residents. The attending plays god to all (well, except maybe the insurance companies). The system truly teaches many, especially the insecure and abused, to find someone to look down on. This classic case of displacement is prevalent in the medical training. Many desperately look to place someone beneath them in order to build up their self-esteem. Besides, they weren’t as smart as we were when we were premeds. Or, they weren’t bright enough to get into a US medical school let alone my higher ranked institution. Maybe they couldn’t get into medicine so they chose a “lesser” profession. Or they didn’t score high enough to get into my specialty. There’s always a way to elevate oneself.

Be Humble

Over and over again, I have witnessed and continue to witness medical doctors put down trainees, colleagues and even patients in order to magnify their own personal brilliance. Quite honestly, this disheartens me. As physicians and soon to be physicians, we are privileged to be members of a very prestigious community with good job security and influence. This however does not make us better than the next woman or man. A time will come when friends, family members, drug reps, patients, and strangers will see you in a white coat and fill your head up with praises. You will win awards, be asked to give presentations, and be applauded for charitable donations or activities. You will deserve these things because you’ve worked extremely hard but a conscious effort is necessary to keep yourself grounded. Always, remember you did not get there by yourself. Give thanks to all those who picked you up when you were down and those mentors who showed you the ropes. Appreciate the significant others who stuck by your side through the journey. Think back to the doubts and failures you had. The times you wondered if it was a mistake that you somehow made it this far. On that day, you get the news that you have been accepted to medical school, celebrate and celebrate well, but remember that day my friend. Remember the struggle and allow it to keep you humble.

PS… Don’t forget to call your mother!  


Written By Dr. Daniel

Internet and Facebook Addiction

Internet addiction is a compulsive disorder that impacts a significant number of individuals in the United States and worldwide. Internet addiction is a preoccupation with the Internet that includes excessive usage, unsuccessful attempts to quit, and using the Internet to escape problems. Individuals who experience Internet addiction demonstrate characteristics similar to other behavioral addicts, including salience, mood changes, and conflict in their lives. Furthermore, individuals addicted to the Internet experience psychological issues, such as depression, anxiety and suicide ideation, as well as cognitive issues, such as difficulties with executive functioning. Neuroimaging studies provide support for changes in neuronal connections associated with Internet addiction, particularly in areas of the brain related to emotions and impulse control. Grounded in the principles of cognitive psychology is Internet and Facebook addiction, as these forms of media tend to offer variable interval schedules of reinforcement, rewards, and punishment. It is no surprise that a major approach to treating this form of addiction uses cognitive behavioral therapy. ADD SUBJECT should give this disorder a permanent place within the field of psychiatry as an official psychiatric diagnosis because of the psychological and biological evidence in support of the existence of an Internet addiction.

The Internet has significantly impacted society. This form of communication allows scientists to share knowledge to a worldwide audience, allows companies to conduct business on a global scale, and instantly places information about virtually any topic at the fingertips of ordinary citizens. Social media, such a Facebook, enables individuals from around the world to connect with each other at any time, sharing photographs, insights about their lives, or the latest YouTube video. The Internet, including social media, has truly transformed communication.

In spite of the benefits afforded by the Internet and social media, there is a downside. Some individuals are unable to self-regulate their time appropriately and develop an addiction. For example, 19 year-old Ryan played online computer games for up to 32 hours at a time, leading to failing out of college. Peter, a 30 year-old sex addict, was unable to control his use of Internet porn. Both young men are residents of reSTART, a residential Internet addiction facility located in Seattle, Washington (Campoamor, 2016). Internet addiction is comparable to, and defined in a similar manner as, a gambling addiction or an impulse control disorder, which includes characteristics such as a preoccupation with the Internet, large amounts of time spent on the activity, irritability with loss of access, unsuccessful attempts to quit, lying to cover up use, and using the Internet to escape problems (Northrup, et al., 2015). Although not all researchers agree on the specific diagnostic criteria associated with Internet addiction, consensus appears to exist regarding the presence of excessive Internet use, withdrawal symptoms such as depression or anger when use there is restricted use, a tolerance characterized by increased use of the Internet to control negative emotions, and negative consequences, such as problems with relationships or employment (Northrup, et al., 2015; Griffiths, & Kuss, 2015, p.393). These characteristics suggest that excessive or uncontrollable Internet and social media use can lead to significant disruptions in one’s life.

This form of addiction is a prevalent problem worldwide. According to Cheng and Li (2014), the global prevalence of this problem is 6%, which is just below the 8% prevalence in the Unites States. The highest prevalence of Internet addiction exists in the Middle East, with 10.9% of Internet users classified as addicts (Cheng, & Li, 2014). While these figures refer to individuals with an average age of 18 years, research suggests that younger adolescents are not immune from addiction. Ha and Hwang (2014) reported an Internet addiction rate of 2.8% among adolescents between 11-19 years. Internet addiction appears to span from adolescence into adulthood.

Although research exists that addresses the issue of Internet and social media addiction, the psychiatric profession has not yet officially recognized these problems as true behavioral addictions. In fact, the only behavioral addiction currently addressed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is pathological gambling (Andreassen, et al., 2012). However, the DSM-5 has determined that a diagnosis of Internet Gaming Disorder warrants further attention for possible inclusion in the manual (American Psychiatric Association, 2013). In spite of the lack of formal recognition, research evidence pertaining to the characteristics of Internet and social media addicts, the cognitive-behavioral model of problematic Internet use, and the consequences of excessive use strongly suggests that Internet and Facebook addiction is a true disorder.

Characteristics of Internet and Facebook Addicts

Addictive Behaviors

Behavioral addicts, such as those addicted to the Internet, share a number of common characteristics. The criteria for behavioral addiction include salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse (Rosenberg, & Feeder, 2014, p.3). Salience refers to the degree of importance in a person’s life. In this regard, for an addict, the Internet would dominate his thoughts and behaviors. Mood modification, another behavioral criteria, refers to the resulting emotional effect after performing the behavior. Some individuals may feel an adrenaline rush, while others may feel a peaceful sense of escapism. Tolerance refers to an increasing amount of behavior needed to achieve the same effects, while withdrawal symptoms are unpleasant feelings that result from the inability to engage in the behavior. Conflict refers to the clash between the addict and other individuals or activities within that person’s life. Conflict may also occur within the individual, such as struggling with a loss of control. Finally, relapse occurs when the individual returns to previously harmful or excessive behaviors after a period of cessation (Rosenberg, & Feeder, 2014, p.3). These characteristics of behavioral addicts may also apply to those with problematic Internet use.

Individuals with problematic Internet or Facebook use demonstrate a number of different characteristics suggestive of addiction. For example, Internet addiction positively correlates with impulsivity, anxiety, aggression, and hostility. Capetillo-Ventura, and Juarez-Trevino (2015) reported that medical students who scored at a level indicative of addiction on Young’s Internet Addiction test were more likely to be impulsive, anxious, aggressive, and demonstrate less work effort. These individuals also demonstrated a higher propensity for insomnia, social dysfunction, and depression. Individuals with Internet addiction and social dysfunction are more likely to demonstrate hostility, paranoia, lower levels of social responsibility and family support, as well as negative coping strategies (Qiang, et al., 2015).

Also associated with the traits of neuroticism and extraversion is Internet addiction, or more specifically, Facebook addiction. Scores on the Bergen Facebook Addiction Scale (BFAS) that assess for the six primary characteristics of behavioral addiction, correlated with neuroticism, which refers to emotional instability or the tendency to express negative emotions, and extraversion, which refers to being full of energy and willing to engage with the outside world. In addition, scores on this assessment negatively correlated with conscientiousness, which refers to self-discipline and impulse control (Adreassen, et al., 2012; Wu, et al., 2015).

Risk Factors for Internet Addiction

There are a number of risk factors that serve as predictors of Internet and Facebook addiction. Predictors of Internet addiction include the presence of Internet access at home, male gender, increased income level, and time spent online gaming (Ak, Koruklu, & Yilmaz, 2013). Predictors of Facebook addiction include time commitment, social motivations, depression, anxiety, and insomnia. Demographics other than income level and gender, as well as the desire to obtain information for academic or personal purposes, do not serve as risk factors for Internet addiction (Koc, & Gulyagci, 2013).

Biological Evidence

The evidence supporting Internet and Facebook addiction as a real addiction includes neurological factors. Magnetic resonance imaging of the brains of individuals with Internet addictions demonstrate patterns consistent with those of other types of addicts. For example, associated with Internet addiction is the activation of the amygdala-striatal system, an area of the brain involved in impulse control (Turel, et al., 2014). Internet addicts also demonstrate disruptions in the frontal, occipital, and parietal lobes (Wee, et al., 2014). Associated with impairments in the ability to process information and emotions, learning and memory, and executive function are these disruptions (Wee, et al., 2014).

Psychiatric Comorbidities

Psychiatric comorbidities often accompanies Internet addiction. Individuals who score higher on measures of Internet addiction are more likely diagnosed with psychiatric comorbidities and are at increased risk of suicide ideation and attempts (Wu, et al., 2015). For example, in a study of 1,100 individuals drawn from the general public, Wu, et al. (2015) reported that 65% of Internet addicts possess another psychiatric diagnosis, 47% of addicts had thought about suicide within the past week, and 23% had attempted suicide at least once in their lifetimes. In addition, Internet addiction positively correlates with alcohol abuse, attention-deficit hyperactivity disorder, depression, and anxiety (Ho, et al., 2014).

Assessment Tools

Psychologists have developed assessment tools to measure Internet and Facebook addiction. Young’s Internet Addiction Test classifies individuals as average Internet users, those whose usage causes frequent daily problems, and those whose Internet usage causes significant daily problems. Although widely used, this test only detects 42% of Internet addicts in a clinical population (Kim, et al., 2013). In an effort to improve upon this, Northrup, et al. (2015) developed the Internet Process Addiction Test, which focuses on the different uses of the Internet. This assessment tool measures the frequency of use of the Internet to engage in different processes, including surfing, gaming, social networking, and gambling. Other questions pertain to the use of the Internet for escapism, attempts to decrease Internet use, loss of interest in other activities, and using the Internet in spite of harmful consequences such as missed school or relationship problems (Northrup, et al., 2015). An additional psychological assessment tool is the Bergen Facebook Addiction Scale that assesses for the six elements of addiction, including salience, mood changes, tolerance, withdrawal, conflict, and relapse (Adreassen, et al., 2012).

Internet and Facebook Addiction from a Cognitive-Behavioral Perspective

Social networking sites possess characteristics that encourage addiction, including variable interval schedules of reinforcement, classically conditioned cues, physiological arousal, and the activation of the appetite pathway (Hormes, Kearns, & Timko, 2014). A variable interval schedule of reinforcement reinforces a behavior after an inconsistent amount of time. On Facebook, this occurs when Facebook users post new material online. Since these posts occur at random time points, the reinforcement occurs at varying intervals. An example of a classically conditioned queue is the mobile notifications that occur when a Facebook user’s friends post new content. These cues serve as reinforcers for the behavior of Facebook usage. Furthermore, physiological arousal, such as a sense of excitement or anxiety, occurs as well as activation of the appetite pathway, which leads to hunger and the desire for food intake (Hormes, Kearns, & Timko, 2014).

Facebook games, such as Candy Crush Saga, also demonstrate a foundation in cognitive psychology. Groves, Skues, and Wise (2014) examined the features of online games in order to determine how they encouraged problematic Internet use. The authors analyzed 10 popular games on Facebook, including tile matching games and simulation and role-playing games. One feature of tile matching games that encourages excessive use is the achievement-related status updates, such as posting high scores. This reinforces the idea of competition and serves as a reminder to continue playing the game. In addition, notifications by friends requesting additional lives or extra moves can prompt users to return to the game to help their friends (Groves, Skues, & Wise, 2014).

Tile matching games also use reward and punishment features to encourage participation. Rewards include the ability to view one’s progress in the game and how that progress compares with friends. In addition, players may earn special tokens or prizes to help them complete additional levels. Punishment takes the form of a limited number of lives for each round of play. When one runs out of lives, that forces the user to stop playing or, in some cases, use actual money to purchase additional lives (Groves, Skues, & Wise, 2014).

The Cognitive-Behavioral Model of Generalized and Problematic Internet Use may explain Internet addiction. This model contains a number of direct and indirect relationships among factors related to problematic Internet use. For example, a preference for online social interactions significantly relates with both mood regulation and deficits in self-regulation. The latter of these two factors, mood regulation and efficient self-regulation also correlate with each other. These relationships suggest that individuals who use the Internet as a means to cope with negative emotions are less likely able to regulate their activity online. Another relationship exists between deficits in self-regulation and negative consequences. Individuals who have difficulty regulating their time on the Internet are at increased risk for experiencing negative consequences, such as difficulty in school or with interpersonal relationships (Gamez-Guadix, Orue, & Calvete, 2013).

This model also highlights indirect relationships between variables associated with Internet use. Deficient self-regulation, such as that demonstrated through obsessions and compulsions, serves as a mediating role between online social interaction or mood regulation and negative consequences (Gamez-Guadix, Orue, & Calvete, 2013). In other words, difficulty with the self-regulation of Internet use determines in part the types of consequences experienced as a result of participation in social media or the use of the Internet to regulate one’s mood.

Negative Consequences of Internet and Facebook Addiction

As with any type of addiction, Internet and Facebook addiction can have detrimental consequences. Li, et al., (2015) used a focus group approach to investigate health or psychosocial consequences associated with excessive Internet use among 27 university students. In this study, they defined excessive Internet use as 25 or more hours per week spent online. Participants in this study first access the Internet at a mean age of 9.3 years and first acknowledged having a problem with Internet use at the age of 16.2 years. Several themes emerged from the focus group data. Students identified a number of factors that triggered their Internet use, including strong feelings and moods, boredom, stress, and as a means of escaping difficult situations. A second theme emerging from this study was that participants typically use the Internet in order to engage in social media, complete schoolwork, or participate in other Internet activities such as video games or posting on forums. The third theme of this study directly addressed the consequences of excessive Internet use. Participants reported adverse health consequences such as sleep deprivation, lack of exercise, and poor posture. Psychological consequences included anger, frustration, sadness and depression, as well as discomfort with face-to-face communication (Li, et al., 2015).

Just as excessive Internet use associates with negative consequences, so does excessive Facebook use. Kittinger, Correia, and Irons (2012) administered the Internet Addiction Test to a sample of undergraduate students in order to investigate the relationship between problematic Internet use and Facebook use. Results indicated that over one-third of research subjects used Facebook more than once a day, and one-fourth more than five times a day. When compared with individuals who used Facebook less than 15 minutes per day, those who used Facebook more than 90 minutes per day experienced increased incidence of being late, being in trouble, losing track of time, and spending too much time online. In addition, excessive users were more likely to be told by someone else that they were addicted to the Internet and were more likely to actually feel addicted to Facebook (Kittinger, Correia, & Irons, 2012). These results suggest that individuals with problematic Facebook use experienced significant difficulties in time management.

Facebook users not only use Facebook for social interaction, but also to play games. For example, a popular game is Candy Crush Saga. In this game, the user must match three candies in order to earn points and rewards that can be used later in the game. Each time a user completes a game board, the game shows his or her score in comparison with the scores of several other friends who have also completed that board. Therefore, not only is there an incentive to complete each game board for the sake of earning points, but there is also an incentive to outscore one’s friends.

Treatment Strategies

Existing treatment strategies for Internet addiction focus on cognitive behavioral therapy. King, et al. (2012) provided a review of cognitive behavioral techniques effective for Internet addiction. These strategies target distorted thoughts or thought processes and the use of reinforcement. The therapist may attempt to modify the client’s maladaptive cognitions related to self and the world as well as help the client improve self-efficacy. Another important aspect of cognitive behavioral therapy is helping the client to identify automatic thoughts related to going online, and the situations that lead to Internet use (King, et al., 2012).

Young (2011) described another treatment model for Internet addiction, the CBT-IA. This model uses cognitive behavioral therapy in conjunction with harm-reduction therapy in a three-phase approach. During the first phase of treatment, the counselor uses behavior modification to help the client reduce the time spent online. In the next phase, the counselor uses cognitive restructuring to combat feelings of denial and justification pertaining to Internet use in the client. Finally, the counselor uses harm reduction therapy to treat any issues related to excessive Internet use. Harm reduction therapy acknowledges that individuals develop addictions because of a variety of different influences in their lives, including biological, social, and psychological factors. The goal of this therapy is to address these other issues while at the same time taking small steps to reduce the harm caused by Internet addiction (Young, 2011).

Response and Critique

Characteristics of Internet and Facebook Addicts

One of the most convincing arguments for the existence of an Internet or Facebook addiction is that individuals with these problems demonstrate the characteristics of behavioral addictions. Rosenberg and Feeder (2014) discussed six of these characteristics, including salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse. For individuals with an Internet addiction, it is evident that this form of communication plays a salient role in their lives. For example, Li, et al. (2015) studied a group of students who use the Internet excessively, defining excessive use as greater than 25 hours per week online. In addition, participants in this study reported negative consequences such as sleep deprivation and lack of exercise. Taken together, these pieces of data suggest that the study subjects placed high importance on Internet usage. Twenty-five hours per week is a significant amount of time to spend on one activity. In fact, it is probably similar to the amount of time a college student spends in class and studying or working a part-time job. Furthermore, the activity of Internet use appears to be more importance than sleep or exercise for some of these individuals. Results from this study support the idea that, among addicts, the Internet is salient in their lives.

Another characteristic common to behavioral addicts is mood modification. The research presented in the literature review supports the occurrence of mood changes resulting from Internet use. For example, some individuals who use the Internet excessively demonstrate increased aggression and hostility (Capetillo-Ventura, & Juarez-Trevino, 2015), while others may demonstrate paranoia, depression, anger, frustration, or discomfort (Qiang, et al., 2015; Li, et al., 2015). Since these moods associate with excessive Internet use, it stands to reason these moods do not occur when individuals are not using the Internet. Mood changes associated with the behavior of Internet or social media use are indicative of an addiction.

Conflict is another characteristic of addiction that appears prevalent among Internet addicts. Excessive Internet use associates with social dysfunction and lower levels of family support (Qiant, et al., 2015). Another character trait of an excessive Internet user is emotionally unstable (Adreassen, et al., 2012) and having difficulty with face-to-face communication (Li, et al., 2015). These characteristics suggest that individuals addicted to the Internet have difficulty with interpersonal relationships. These individuals may have difficulty communicating with others outside of the online world and may have difficulty controlling their emotions when they do. A lack of family support could also indicate conflict within the family related to Internet use.

The remaining characteristics of behavioral addiction, including tolerance, withdrawal symptoms, and relapse, did not seem to be a focus of the literature. It would be interesting to conduct additional studies investigating the physical and psychological effects of Internet use cessation among those who use it excessively. In addition, another interesting study would investigate how Internet usage time has increased among potential Internet addicts. Studies such as these could potentially provide additional support for the inclusion of Internet addiction as an official psychiatric diagnosis.

One of the more interesting findings in this literature review was the biological evidence that suggests the brains of Internet addicts differ from those without the addiction. Studies suggested that certain areas of the brain were more active in addicts, such as the areas involved in impulse control (Turel, et al., 2014), emotions, and executive function (Wee, et al., 2014). These findings seem reasonable, as Internet addicts tend to experience a number of emotions, such as anxiety and depression.

Executive functioning plays an important role in time management. Results from the study by Kittinger, et al. (2012) provided interesting insights into this phenomenon. Subjects in this research study who used Facebook more than 90 minutes per day reported an increased incidence of being late and losing track of time. If Internet addiction associates with changes in the portion of the brain related to executive functioning, it makes sense that individuals with this problem would have difficulty keeping track of time.

Impulse control was another area addressed in the neuroimaging study. In relation to this, Ho, et al. (2014) reported that Internet addiction positively correlated with attention-deficit hyperactivity disorder, a disorder characterized in part by a lack of impulse control. Furthermore, higher scores on an assessment of Internet addiction demonstrated a negative correlation to self-discipline and impulse control (Adreassen, et al., 2012; Wu, et al., 2015). It is interesting that biological studies of the brain supports psychological studies of behavior. Taken together, this evidence suggests that excessive Internet use is not just a psychological issue, but a biological one as well.


One of the most disturbing findings in this literature review was the association of Internet addiction with suicide. Ho, et al. (2014) reported that, among a sample of Internet addicts, 47% of them had thought about suicide during the past seven days, and 23% of them had actually attempted suicide at some point in their life. This is not necessarily surprising, given the relationship between suicide and feelings of depression (Ho, et al., 2014). However, when one considers that about 8% of residents in the United States may be classified as Internet addicts (Cheng, & Li, 2014), this means that of the approximate 28 million addicts (given an approximate population of 350 million in the United States), just over 13 million individuals have thought about suicide in the past week. These numbers are frightening, and they highlight the necessity of identifying and treating those who are addicted to the Internet.

Cognitive Principles Associated with Internet Addiction

According to the body of literature surrounding Internet and Facebook addiction, there appears to be underlying cognitive components to the disorder. One of the most notable characteristics of Facebook use is the presence of variable interval schedules of reinforcement (Hormes, Kearns, & Timko, 2014). Users of Facebook have the ability to download an app onto their mobile phones that will provide notifications every time a Facebook page updates. For example, if a Facebook friend posts a new comment or a video, the individual receives a visual and auditory signal on the mobile phone. Since Facebook friends may post comments or information at any time of day and any number of times, there is likely no consistent pattern to the notifications. Therefore, reinforcement of the behavior to use Facebook occurs at variable intervals, as the individual reads the notifications and then checks the Facebook page.

The Cognitive-Behavioral Model of Generalized and Problematic Internet Use provides interesting insight into the cognitive aspects of Internet addiction. The two most prevalent components of this model appeared to be mood regulation and deficits in self-regulation (Gamez-Guadix, Orue, & Calvete, 2013). The latter of these, deficits in self-regulation, may relate to difficulty with impulse control. This lack of impulse control or self-regulation associates with negative consequences, such as difficulty in school or with interpersonal relationships. Success in school depends in part upon self-discipline and the willingness to put forth effort at learning. Individuals who have difficulty with self-regulation may struggle with using their time wisely. Rather than complete homework or study first, the addicted individual may give into the desire to use the Internet.

Diagnosis and Treatment of Internet Addiction

A number of diagnostic tools are available to help identify individuals who likely struggle with Internet or Facebook addiction. The fact that these tools exist is evidence that members of the scientific community do consider Internet addiction a true disorder. According to Kim, et al. (2013), one of the most widely used assessment tools, Young’s Internet Addiction Test, can only detect 42% of Internet addicts within a clinical population. This is not an encouraging number and one that suggests a need for a more valid tool. It appears that Northrup, et al. (2015) developed such a tool by modifying the original test to focus on the processes associated with Internet addiction. The elements of this new test demonstrated strong and statistically significant correlations with the scales of Young’s Internet Addiction Test (Northrup, et al., 2015). Thus, Northrup, et al. (2015) contended that their version of the Internet addiction test possessed high levels of convergent and concurrent validity. However, the authors did not report on the reliability of their assessment tool. Therefore, one should use caution when using this new tool in diagnosing Internet addiction.

While it may not be feasible to use these tests as screening tools in schools, it may be important for educators to at least recognize the risk factors associated with Internet addiction. Pertinent risk factors include male gender, time spent gaming or online, depression, anxiety, and insomnia (Ak, et al., 2013; Koc, & Gulyagci, 2013). Educators spend a great deal of time with students and are in a position to notice these risk factors and act upon them. One risk factor mentioned in the literature was access to Internet in the home (Ak, et al., 2013). This particular risk factor was self-evident, as without Internet access in the home, individuals are not likely to find significant amounts of time to spend online. It is possible that Internet addiction could cross over into the workplace, and employees could spend excessive amounts of time online at their place of employment. However, employers would likely discover these individuals quickly, which could prevent or severely reduce Internet access.

Individuals who struggle with Internet addiction may find hope through cognitive behavioral therapy. Although the research evidence in support of this therapy is limited, it does show promise in reducing addictive behaviors and the resulting symptoms. This form of therapy is effective at reducing Internet usage, improving quality of life and depressive symptoms, and improving time management skills (King, et al., 2012). It makes sense that counselors base an effective treatment on cognitive behavioral therapy given the underlying cognitive aspects of Internet addiction, including reinforcement and punishment. It is interesting to note, however, that King, et al. (2012) also briefly discussed the use of medication in treating this addiction. For example, they associated the use of methylphenidate, a drug used to treat attention deficit disorder, over an eight week period with improved addiction. In addition, they associated the use of bupropion, an anti-depressant, for six weeks with reduced craving for online video games and diminished cue-associated brain activity (King, et al., 2012). Although there is a need for further research, it does appear that there are promising options for those who struggle with Internet addiction.


Although Internet addiction is not recognized as an official mental disorder and debate exists over whether it should, the research evidence suggests it is indeed a true addiction. Individuals addicted to the Internet or Facebook demonstrate a number of characteristics common to individuals with behavioral addictions, including salience, mood changes, and conflict in their lives. Furthermore, as with any addiction, Internet addiction has negative consequences that impact daily functioning and interpersonal relationships. One of the most frightening negative consequences is suicide ideation. The association of suicide ideation with Internet addiction, as well as the many negative outcomes associated with this compulsive behavior, underscores the need to acknowledge Internet addiction as an official psychiatric disorder. By acknowledging Internet addiction as a disorder, scientists and psychiatrists are more likely to devote time in developing improved diagnostic tools and effective treatment strategies.


Ak, S., Koruklu, N., & Yilmaz, Y. (2013). A study on Turkish adolescent’s Internet use: Possible predictors of Internet addiction. Cyberpsychology, Behavior, and Social Networking, 16(3), 205-209. doi:10.1089/cyber.2012.0255

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, D.C.: American Psychiatric Association.

Andreassen, C.S., Torsheim, T., Brunborg, G.S., & Pallesen, S. (2012). Development of a Facebook Addiction Scale. Psychological Reports, 110(2), 501-517. doi:10.2466/02.09.18.PRO.110.2.501-517

Campoamor, D. (2016, March 4). Unplugged: What a day at an Internet addiction recovery center taught me. Huffington Post. Retrieved from

Capetillo-Ventura, N., & Juarez-Trevino, M. (2015). Internet addiction in university medical students. Medicina Universitaria, 17(67), 88-93. doi:10.1016/j.rmu.2015.02.003

Cheng, C., & Li, A.Y.I. (2014). Internet addiction prevalence and quality of (real) life: A meta-analysis of 31 nations across seven world regions. Cyberpsychology, Behavior, and Social Networking, 112(3), 755-760. doi:10.1089/cyber.2014.0317

Gamez-Guidix, M., Orue, I., & Calvete, E. (2013). Evaluation of the Cognitive-Behavioral Model of Generalized and Problematic Internet Use in Spanish adolescents. Psicothema, 25(3), 299-306. doi:10.7334/psicothema2012.274

Griffiths, M.D., & Kuss, D.J. (2015). Online addictions: Gambling, video gaming, and social networking. In S.S. Sundar (Ed.), The handbook of the psychology of communication technology (384-404). Malden, MA: John Wiley & Sons.

Groves, J., Skues, J.L., & Wise, L.Z. (2014). Assessing the potential risks associated with Facebook game use. International Journal of Mental Health & Addiction, 12, 670-685. doi:10.1007/s11469-014-9502-5

Ha, Y.M., & Hwang, W. (2014). Gender differences in Internet addiction associated with psychological health indicators among adolescents using a national web-based survey. International Journal of Mental Health & Addiction, 12(5), 660-669. doi:10.1007/s11469-014-9500-7

Ho, R.C., Zhang, M.W.B., Tsang, T.Y., Toh, A.H., Fang, P., Yanxia, L., … Kwok-Kei, M. (2014). The association between Internet addiction and psychiatric cormobidity: A meta-analysis. BMC Psychiatry, 14(1), 284-306. doi:10.1186/1471-244X-14-183

Hormes, J.M., Kearns, B., & Timko, C.A. (2014). Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits. Addiction, 109(12), 2079-2088. doi:10.1111/add.12713

Kim, S.J., Park, D.H., Ryu, S.H., Yu, J., & Ha, J.H. (2013). Usefulness of Young’s Internet Addiction Test for clinical populations. Nordic Journal of Psychiatry, 67(6), 393-399. doi:10.3109/08039488.2012.748826

King, D.L., Delfabbro, P.H., Griffiths, M.D., & Gradisar, M. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

Kittinger, R., Correia, C.J., & Irons, J.G. (2012). Relationship between Facebook use and problematic Internet use among college students. CyberPsychology, Behavior, & Social Networking, 15(6), 324-327. doi:10.1089/cyber.2010.0410

Koc, M., & Gulyagci, S. (2013). Facebook addiction among Turkish college students: The role of psychological health, demographic, and usage characteristics. CyberPsychology, Behavior, & Social Networking, 16(4), 279-284. doi:10.1089/cyber.2012.0249

Li, W., O’Brien, J.E., Snyder, S.M., & Howard, M.O. (2015). Characteristics of Internet addiction/pathological Internet use in U.S. university students: A qualitative-method investigation. PLoS One, 10(2), 1-19. doi:10.1371/journal.pone.0117372

Northrup, J.C., Lapierre, C., Kirk, J., & Rae, C. (2015). The Internet Process Addiction Test: Screening for addictions to processes facilitated by the Internet. Behavioral Sciences, 5(3), 341-352. doi:10.3390/bs5030341

Qiang, C., Xing, Q., Huimin, L.U., Pei, F.E.I., & Ming, L.I. (2015). Comparison of the personality and other psychological factors of students with Internet addiction who do and do not have associated social dysfunction. Shanghai Archives of Psychiatry, 27(1), 36-41. doi:10.11919/j.issn.1002-0829.214129

Rosenberg, K.P., & Feeder, L.C. (2014). Behavioral addictions: Criteria, evidence, and treatment. New York: Academic Press.

Turel, O., Qinghua, H., Gui, X., Lin, X., & Bechara, A. (2014). Examination of neural systems sub-serving Facebook “addiction”. Psychological Reports, 115(3), 675-695. doi:10.2466/18.PR0.115c31z8

Wee, C.Y., Zhao, Z., Yap, P.T., Wu, G., Shi, F., Price, T., … Shen, D. (2014). Disrupted brain functional network in Internet Addiction Disorder: A resting-state functional magnetic resonance imaging study. PLoS One, 9(9), 1-11. doi:10.1371/journal.pone.0107306

Wu, C.Y., Lee, M.B., Liao, S.C., & Chang, L.R. (2015). Risk factors of Internet addiction among Internet users: An online questionnaire survey. PLoS One, 10(10), 1-10. doi:10.1371/journal.pone.0137506

Young, K.S. (2011). CBT-IA: The first treatment model for Internet addiction. Journal of Cognitive Psychotherapy, 25(4), 304-312.

Leadership in a Health Context

While some individuals may be born leaders, many leaders experience success due to an intentional desire for self-improvement and a genuine concern for the welfare of others. As a future leader in healthcare, I intend to strengthen those skills that will enable me to be effective at creating a shared vision with my colleagues. The first step in strengthening leadership skills is to uncover the skills I may already possess and those which need to be developed. After completing a leadership skills inventory and interviewing three individuals who are familiar with my skills and qualities, I recognize that my decisive and detail-oriented nature may prove beneficial as a leader, as will the further development of qualities such as humility and recognizing my own limitations.

Leadership Experiences

Several significant experiences have helped to shape my leadership skills. Arguably the most traumatic event of my life occurred at an early age when my mother and older sister were in a car accident. My sister was pronounced dead upon arrival at the hospital, while my mother lingered for three months in a coma before passing away. Amidst the shock and grief, I was thrust into the role of caregiver to my two younger siblings. My father continued to work during the months following the accident, and I stepped in to fill the role of my mother. In addition to my school responsibilities, I took charge of the household and ensured that my family had meals to eat and a clean house in which to live. I helped my younger brother and sister with their homework and, more importantly, helped them to cope with the loss of their mother and sister. The months following the accident were emotionally draining and physically exhausting, but I learned that I am able to think clearly and put my own needs aside for the benefit of others when faced with a traumatic crisis. In addition, my experiences in the hospital communicating with my mother’s physicians and nurses and striving to understand her condition ignited in me an interest in medicine.

Another leadership opportunity arose during my undergraduate schooling. I was fortunate to have the opportunity to perform research with my advisor during my junior and senior year at the university. In addition to assisting a graduate student with her research project, I was tasked with training other undergraduate students in relevant research techniques, such as conducting interviews and using different pain assessment tools. My advisor also gave me the responsibility of maintaining a research database and ensuring that adequate amounts of all supplies were available. During my senior year, I designed and conducted my own investigation related to the effects of different pain management techniques on lower back pain. I had the opportunity to present my research to members of the physical therapy department prior to graduation. This leadership experience enabled me to strengthen my knowledge of physical therapy and medicine and gave me confidence in seeing a project through from beginning to completion. The knowledge I gained during my time performing research will benefit me as I study medicine in the future.

A third significant leadership opportunity allowed me to organize volunteers for the local food bank. Once per month our food bank asked volunteers to pack boxes of food for low-income senior citizens. I volunteered with the organization for three years and I was asked to coordinate the volunteer groups who requested to work on specific days. I was responsible for contacting group leaders and arranging a time for them to work at the food bank, as well as training each group on the required tasks when they arrived.

These experiences, particularly the death of my sister and mother, enabled me to begin to develop qualities associated with adaptive leadership. Adaptive leadership assumes a shared responsibility for the future of the organization. Rather than limiting oneself to identifying only with specific roles and functions, organizational members demonstrate a shared sense of responsibility for the good of the whole organization (Heifetz, Grashow, & Linsky, 2009). After the death of my mother, I expanded my sense of responsibility beyond that of myself to that of my entire family. Rather than just worry about my own needs, I now assumed the responsibility for making choices that were in the best interest of our family as a whole. This experience taught me a great deal about putting others’ needs before one’s own needs.

Desired Leadership Characteristics: Ideal Self

The information I gleaned from the Friendly Style Profile provided interesting insights into my leadership styles. I realized that I react differently in times of calm, or the everyday stressors of life, than in times of storm, or the distressing events and crises. I achieved the highest score in the “calm” category for Affiliating/Perfecting (32), suggesting that I strive for excellence in the everyday tasks and situations that occupy my time. I do recognize this quality in myself, as I tend to be a perfectionist and place high expectations upon myself. However, a stress shift occurs when crises hit, and my style changes to Achieving/Directing (29). Individuals who score high in this category seek quick and decisive actions during times of stress or crisis (The Friendly Style Profile, 2004). This style would be particularly beneficial for professionals in the medical field, as they often must cope with health crises in their patients. These qualities will benefit me as I pursue my dream of becoming a physician, especially if I choose to work in an emergency department where quick and decisive actions are paramount.

The qualities of striving for excellence and making quick, decisive actions are important components of the leader I desire to be, yet improvements are warranted. Collins (2001) emphasized the importance of humility in leadership. Leaders demonstrate humility when they give credit to others and external factors for successes yet accept personal responsibility for failures. These types of leaders also reject mediocrity, demonstrating resolve in order to accomplish goals (Collins, 2001). My perfectionist approach does not align well with the idea of humility. Rather than trying to accomplish goals on my own, I need to learn when to rely on others, sometimes giving up control to my peers. I still seek excellence in my work and often feel a sense of resolve when faced with a task. However, as a leader I want to turn the attention away from myself at times and focus on the needs of those I serve.

In addition to humility, I desire to demonstrate the characteristics of a transformational leader. Transformational leaders serve as role models to others and inspire a positive vision of the future. Rather than dole out responsibilities, transformational leaders encourage creativity and innovation. These types of leaders promote autonomy while at the same time providing the encouragement and support employees need to make effective decisions (Richter, et al., 2016). As I often tend to assume the responsibility for the completion of tasks by myself, I need to learn to support others in accomplishing common goals and recognize that teamwork is an important part of leadership.

In summary, there are several characteristics that I possess which align with my vision of leadership, while there are others which warrant improvement. I strive for excellence in my work, a quality that may help me to inspire others to reach their fullest potential. In addition, I seek to be decisive when faced with a decision or choice, a quality that may help me to create a clear vision within my future organization. However, my quest for excellence sometimes resembles perfectionism, which can lead to unrealistic expectations placed upon myself and others. If my goal is to motivate and inspire others, I must develop realistic expectations and provide the support for others to succeed. In addition, an improved sense of humility will help me to remember that any successful team effort is truly the result of collaboration, not any one individual working within the limelight.

Others’ Perceptions of My Leadership Skills: Real Self

In order to gain insight into others’ perception of my leadership skills, I conducted interviews with three individuals familiar with my abilities. The interviewees included a peer from my undergraduate days as a pre-med major, the physical therapist who served as my research advisor, and a volunteer at the food bank. Upon analysis and reflection of the interview results, three themes emerged.

The first common theme among all three interviewees was that of decisiveness or confidence in my decisions. My former classmate commented that I always seemed “sure” of myself and my decisions. She reported the perception that I was confident in my course choices, as well as the career path I desired to pursue. My research advisor noted a similar pattern of behavior, commenting that as I conducted my independent research project during my senior year, I demonstrated confidence in my choices and a clear direction in how to answer my research question. The gentleman with whom I have scheduled volunteer work at the food bank commented that I made quick and confident decisions when allocating the work to the different volunteers when packing food boxes.

A second theme that emerged among the three interviews was my detail-oriented approach to solving problems and completing my work. My research advisor commented that I conducted thorough interviews of our research subjects. I remember contacting several research subjects for follow-up questions, as I wanted to be thorough when collecting data. My advisor also noted that my description of the methodology section in the paper in which I summarized my research project was detailed enough that other individuals could repeat my investigations merely by reading the paper. The volunteer at the food bank relayed similar comments, although in a different context. He commended me for my sense of organization, which included ensuring that pallets of similar foods were placed near each other for packing. In addition, he noted that I paid attention to details important to the volunteers, such as ensuring that they had mats to stand on during their time on the “assembly line”, enough snacks and drinks for the break, and adequate amounts of all necessary supplies, such as packaging tape and markers.

Attention to detail is a valuable quality, but one that can also hinder performance. I noticed that during some of my biology and chemistry classes as an undergraduate that it was easy to become “lost” in the details and lose sight of the big picture. This occurred at times during my research experience as well. There were times that I was so concerned about recording every small detail about a procedure or interview that I briefly lost sight of my overall goals. Effective leaders should constantly have the “big picture” in mind when setting goals and encouraging teammates.

While the first two themes, decisiveness and detail-oriented, are positive leadership qualities, the third theme represented an area for improvement. Two of the interviewees commented that I tend to take on too much responsibility at times, which can lead to stress. My college peer noted that I tended to overbook my course schedule, resulting in little free time to enjoy other activities. I wanted to take advantage of every opportunity to gain knowledge useful in my pursuit of a career in medicine. However, in doing so I often stretched my limits and became overwhelmed. My research advisor reminded me that while enrolled in 18 credits of coursework and involved in research, I also worked a part-time job. I enjoy challenges and prefer to stay busy, however this may hinder my success in some cases. When I spread myself too thin, I feel that I struggle to excel in different areas as I am not able to devote my full attention to any one area. As I move forward, I plan to work on improving this aspect of my life.

The tendency to take on too much responsibility may be detrimental to myself and others as a leader. Excessive stress can lead to negative outcomes, both emotionally and physically. Leaders must be able to recognize and manage stress within themselves first if they are to be able to help others do the same. Individuals with a Type A personality, who demonstrate a compulsive need for control, are at increased risk for stress and stress-related outcomes (Stickle, & Scott, 2016). Although I do not believe I fit into the Type A personality category completely, my detail-oriented nature and the desire to complete tasks myself rather than delegate them when appropriate could lead to stress. Therefore, I must learn to recognize signs of stress in myself and the precipitating factors and take steps to manage that stress.

Learning Agenda

As I project myself into the future and into my medical career, I must consider the types of leadership skills that will enable healthcare professionals to excel at patient care. An emerging model of healthcare leadership is the collaborative model. This model reflects a shift in perspective from a traditional “command and control” approach to one that is more inclusive. Rather than exert authority or use position and power to achieve desired goals, healthcare leaders should use influence and create a sense of shared vision and goals among colleagues. The basis for this model is the building of relationships among a variety of individuals, both professionally and within the community (Collins-Nakai, 2006).

Multidisciplinary teams demonstrate the implementation of the collaborative model. These types of teams allow for a greater understanding of the patient within his personal context by integrating different perspectives into the diagnostic and care plan. Different professionals with different areas of expertise collaborate to form a common resolution to health issues (Roncaglia, 2016). For example, an oncology patient may have a team of healthcare providers that includes physicians, nurses, a pharmacist, a psychologist, a social worker, and a physical therapist. Effective leaders of multidisciplinary teams set the culture of the team, motivate the team, ensure open communication among members, and ensure that all team members are able to participate and receive the support they need to do so (Sims, Hewitt, & Harris, 2015).

As healthcare moves in the direction of the collaborative model, as a leader I must be prepared to facilitate change. Bridges and Bridges (2000) described a number of essential steps that leaders can take to ensure a smooth transition in the face of change. Leaders must help others understand why the change is necessary and should ensure that the details related to the change are carefully planned. Since attention to detail is one of my strengths, I feel confident that I can achieve this aspect of promoting change. In addition, leaders should possess an understanding of how others are affected by the change, including what they may be gaining or giving up. Some individuals have difficulty letting go of familiar practices and norms and may need encouragement. Although I tend to be decisive and quick in my decisions, I need to recognize that not everyone functions in that manner. Some individuals benefit from time to ponder a change and how it will affect them before moving forward. In situations of change, I will work to demonstrate empathy and maintain open communication with my colleagues.

It is important to note, as well, that individuals often model the behaviors demonstrated by their leaders. Behavioral neuroscience supports the notion that following, or mirroring, the behaviors of others is hardwired into the brain (Goleman, & Boyatzis, 2008). My hope is that as I strengthen my leadership skills and work as an effective member of a multidisciplinary team, I will serve as a positive role model for leadership skills and help to develop these same skills in others.


The changing healthcare environment to a more collaborative approach represents an exciting transition. As a future leader, I intend to play a positive role in this change, helping others to recognize and work towards common goals and providing them with the encouragement and support they need to achieve them. My decisiveness in the face of stress and my attention to detail will benefit me as I assume leadership positions. I intend to focus on a more shared sense of responsibility with others, a sense of humility, and effective stress management skills as I move forward in my medical career.


Bridges, W., & Bridges, S.M. (2000). Leading transition: A new model for change. Leader to Leader Journal, 16, 1-6.

Collins-Nakai, R. (2006). Leadership in medicine. McGill Journal of Medicine, 9(1), 68-73.

Collins, J. (2001). Level 5 leadership: The triumph of humility and fierce resolve. Harvard Business Review, 79(1), 66-76.

Goleman, D., & Boyatzis, R.E. (2008). Social intelligence and the biology of leadership. Harvard Business Review, 86(9), 74-81.

Heifetz, R., Grashow, A., & Linsky, M. (2009). The practice of adaptive leadership. Boston, MA: Harvard Business Press.

Richter, A., Schwartz, U., Lornudd, C., Lundmark, R., Mosson, R., & Hasson, H. (2016). iLead – a transformational leadership intervention to train healthcare managers’ implementation leadership. Implementation Science, 11, 1-14.

Roncaglia, I. (2016). A practitioner’s perspective of multidisciplinary teams: Analysis of potential barriers and key factors for success. Psychological Thought, 9(1), 15-23.

Sims, S., Hewitt, G., & Harris, R. (2015). Evidence of a shared purpose, critical reflection, innovation, and leadership in interprofessional healthcare teams: A realist synthesis. Journal of Interprofessional Care, 29(3), 209-215.

Stickle, F.E., & Scott, K. (2016). Leadership and occupational stress. Education, 137(1), 27-38.

The Friendly Style Profile. (2004). Eugene, OR: Friendly Press.

Congratulations to Sheryl!  Premed of the Week!

1. Tell us a little bit about yourself.  I’m a nontraditional student preparing my candidacy for medical school. Previously, I earned a Bachelor’s of Science in Education in Community Health and worked in the Corporate Wellness setting before earning my Masters in Education in Health Promotion and Exercise Psychology. In addition, I am a certified Health Education Specialist, Personal Trainer, and Group Fitness Instructor. My master’s thesis was the impact of group exercise motivational climate on body image. I absolutely love the beach and anything Disney, and given that most of my family has moved to southern California, I hope to attend medical school there. Plus, California wines and craft beer are great 🙂

2. Who was your favorite teacher in school and how did he or she impact you?  Being a nontraditional student, my ten-year high school reunion has come and gone, so I’m going to focus on my favorite undergraduate teacher. She was my Human Health and Sexuality professor freshman year, and she encouraged me to become involved with multiple on and off campus activities. Without her support and mentorship, I would not be who I am today.

3. When did you first decide you wanted to become a doctor and why?  When I was a freshman, I thought about the pre-med track, but first semester science courses made me think I wanted to be involved in health via a different route. After six years working with all populations and ages in the health and wellness setting, I realized I yearn to build personal relationships with my patients that involves a holistic approach to medicine. This was especially apparent post master’s working as a health coach. In order to fully work with patients, I need the knowledge of a physician. In addition, I hope to continue to bridge the gap between lifestyle modification prescriptions and decrease weight bias in the healthcare setting.

4. What area of medicine are you interested in? Family Medicine and/or Preventative Health

5. What’s the coolest experience you’ve had so far on your premedical journey? Currently I work as a Family and Youth Specialist at an acute care pediatric mental health hospital. I purposefully picked the job to garner more experience before attending medical school. While accepting the position terrified me at first, I am learning so much! I get to shadow doctors as part of my job and see the behavioral health side to medicine. Therefore, I think it is cool, and has solidified my want to go to medical school.

6. What is your favorite book? I love the Harry Potter series. Specifically related to healthcare, the book, “Motivational Interviewing in Health Care: Helping Patients Change Behavior” by Rollnick, Miller, and Butler is a must-read.

7. Tell us one thing interesting about you that most people don’t know. Mediation saves my brain from overload and competes with sleep for my favorite daily activity.

Nicaragua: A Cultural Immersion That Turned Into A Life-Changing Experience

The perceived notion that cultures other than your own exist is often an arduous concept for us to comprehend. We get caught up in our ideals of what culture should consist of that we either forget or choose to neglect the cultures others embrace. That being said, culture is not defined by one thing in particular. Culture ranges in a variety of aspects, from the sports team you play for, to the country from which you were born. The precise definition of culture presents with much ambiguity; however, a commonly accepted explanation is that culture consists of common beliefs, values, rules and behaviors shared by a given society or group (Bonder and Martin 2013). Over the past several weeks, I was offered the unique opportunity to explore a culture far different from my own through a cross-cultural course taught at Eastern Mennonite University.

The purpose of this cross-cultural course was to provide me with a sense of respect for cultural diversity and ultimately, to gain cultural competence. Cultural competence, which is an on-going process that in order to be successful, requires one to be fully immersed in varying cultures with an open mind and the desire to learn (Bonder and Martin 2013). Nicaragua, the country I had the pleasure of visiting, was full of rich culture, allowing me to learn not only about the people, but also about the geography, sociology, and health care system.

Nicaragua is a remarkable country located in Central America, directly south of Honduras, with a population of approximately six million and growing (Sequeira et al. 2011). In fact, it is the largest, yet most sparsely populated country in Central America. The dominant language spoken in Nicaragua is Spanish, and the primary ethnic group is the Mestizos; however, other languages and ethnicities exist. The health care system of Nicaragua is operated financially based on general taxes (Sequeira et al. 2011). MINSA, which stands for Ministerio de Salud (Ministry of Health), is the primary health care provider to Nicaraguans, providing up to approximately 70% of the population (Sequeira et al. 2011). MINSA’s mission is to provide Nicaraguan citizens with free, universal health services, as well as encourage preventative measures, to promote healthier lifestyles. There are three administrative levels in the public health system known as the central level, SILAIS level, and municipal level. The health services provided at the central and SILAIS level include national reference hospitals and departmental hospitals, while the health services provided at the municipal level include health centers, health posts and community-based clinics (Sequeira et al. 2011). There are roughly 32 hospitals, 28 health centers with beds, 144 health centers without beds, and 855 health posts, all of which are supported and financed through a community-based network. During our time in Nicaragua, we were able to observe first hand, how volunteer health posts function and how it benefits smaller communities within the country (Sequeira et al. 2011). In fact, for the duration of our trip, we participated in house visits, followed by clinics for treatment of patients.


During our initial house visits, we collected personal and medical history information from residents in the San Isidro Community, while paying close attention to specific living conditions to assess whether these conditions may potentially contribute to disease. Based on initial observations, the way people live in this area differs drastically from what I am accustomed to in many circumstances. For instance, the majority of the houses are built with basic materials such as wood, metal, and plastic. These materials, compared to more urbanized, wealthier locations in Nicaragua, appear less sturdy and enclosed. Also, the majority of these houses do not have material floors. The floors are the dirt/ground. According to the providers we were working with, the home is considered clean if the floor has been swept and is clear of debris/leaves. Laundry is washed by hand and hung to dry on a line connected to trees. Many people cook their food over burning wood. Overall, the concept of living is similar in that we cook food, we wash our clothes with water and soap, and we insist on living in a sheltered area for sleeping; however, the way we go about these things is different. Perhaps these differences contribute to health conditions prevalent in the area. Visiting the homes of San Isidro opened my eyes to how people can live so differently from what I am used to. Also, the house visits reminded me of the city of Lima in Mountains Beyond Mountains. Lima was a city, where the poor lived, that was described by dirt paths, convenience stores, metal tin roofs, and unstable housing, surrounded by disease and filth (Kidder 2013). Being a poorer community, it also actually made me wonder how accessible quality healthcare was for these people. The majority of them did not have cars, with most modes of transportation being a motorcycle taxi or by a horse. With San Isidro being about 20-30 minutes from town, and with transportation being limited, I would assume gaining regular access to healthcare would be difficult. This lack of access may also be contributed to the prevalence of disease in this area.


The clinics for San Isidro were held at the local church of San Isidro for three days. The organization of the clinics was two groups, each with three volunteers, a translator, a physician and a patient. We averaged approximately twenty patients per day and the patients we treated ranged in age from infants to the elderly. One of the most severe cases we saw on the first day of clinics was a 62-year old woman. She complained of pain in her leg, pain in her stomach/chest and fatigue. She told us she had her uterus taken out several years ago due to uterine cancer. During her physical examination, we noticed several abnormalities. First, her blood pressure was 160/90. Second, and perhaps most importantly, I palpated a large mass (probably the size of a grapefruit), in her pelvic region. Since her uterus had already been removed, we concluded that she most likely had metastatic reoccurring cancer. This could explain her symptoms of pain in the stomach/pelvic region as well as her fatigue. We recommended she go to the hospital for further treatment; however, she said she was not going to go for reasons unknown. This was hard to accept knowing the patient was in critical condition and we were unable to make a meaningful difference. Unfortunately, she was not the only patient experiencing life-threatening conditions.


Our next patient was a 34-year old female. She presented with pain in her chest, right breast, and right axillary region. She was aware of her history of gastritis, which most likely explained the chest pain. During her physical examination, I palpated a tender mass (probably the size of a grape) in the patient’s right breast. I also palpated swollen, tender lymph nodes in the right axillary region. We recommended the patient get further testing at the hospital, such as a mammogram and biopsy, but the patient said she could not go. It was upsetting to see so many people with complex medical issues that required further medical attention beyond our capabilities, knowing access to that medical attention was very limited. Fortunately, many of the patients we encountered were suffering from illnesses/diseases that are relatively easy to treat with the over-the-counter medications we had in stock. Some of the most common illnesses/diseases we found included asthma, fungal skin infections, parasites, and dry cough. Despite being able to give these medications, many of these individuals require these medications long term and therefore would need access to obtaining them. As mentioned previously, access is most likely limited due to not only transportation but also finances. Other factors, such as cooking with wood and lack of personal hygiene, may also be contributing factors to the persistence of illnesses/diseases.

Every patient we encountered seemed to have something new to offer to my expanding knowledge of the Nicaraguan culture.


Despite initially having automatic ethnocentric thoughts, I made a conscious effort to acknowledge, “my way is not the only way.” Cultural brokers also referred to as cultural translators, cultural clinicians, or cultural navigators depending on their precise role, aided us in our immersion by helping us adjust to the different culture to be able to provide quality health services (Bonder and Martin 2013). Another thing that I had the opportunity to pay attention to during my immersion is that people of our culture often consider people of poorer/sicker countries to not care about their health. In contradiction, however, I noticed quite the opposite. The patients we treated seemed to care about their health and just wanted to feel better. The problem appeared to be a lack of resources, such as transportation, money, and education. While MINSA visits these communities approximately once a month, it is not enough to sustain a healthy community given the conditions. The majority of these visits include preventative methods and house treatments for mosquitos. Aside from that, these communities only get occasional visits from volunteer associations, such as ISL. Many of the people in these communities do not have insurance and do not have adequate access to healthcare. There are public hospitals that give free treatment; however, they are overcrowded, not necessarily easy to get to, and do not appear to be the best of quality.


After three days of clinics in the community of San Isidro, we migrated to another community San Sebastian. In comparison to the previous community, San Isidro, it seemed as though the people were not quite as poor and the housing was improved in many ways. For instance, the materials used to build the homes appeared to be more permanent and sturdy, including the use of concrete cinder blocks. Most of the houses also had toilets, which was a significant upgrade compared to the latrines of the other community. Our clinic was held in a school.

One thing that I noticed during clinic was the language barrier between the physician and us, which in my opinion was a downfall to our experience. Not to say this is her fault by any means, especially since we are guests in her country; however, the doctor did not speak very good English, and we are not very fluent in Spanish. This made clear communication with the physician complicated, resulting in a less ideal learning opportunity from the physician. Don’t get me wrong; I believe she knows what she is doing and makes for an excellent physician; however, the language barrier appeared to make her easily influenced by our opinions of what the treatment options should be. This could be considered a type 1 or type 2 storti incident depending on how you look at it because it was somewhat expected for us to be able to communicate via language (Storti 2001). Having experienced difficulty understanding their language, I can now better understand how those who do not speak English may feel when seeking treatment in the United States.


Following clinics, we were able to visit the public hospital. It was extremely eye opening to see how incredibly lucky we are to have what we have in the United States. The hospital was extremely overcrowded, and the majority of the hospital did not have air conditioning, making for fairly miserable conditions. The bathrooms were disgusting and unsanitary. I asked the physician who was giving us a tour if we could see the operating room and he agreed to show us. Since I am a surgical technician in the United States, it was very intriguing to see the differences. First off, the equipment was outdated and scarce. Also, the operating rooms were not near as clean as they are where I work. The sterile technique, from what I could tell, was not nearly as sterile as what I am accustomed to in the United States. I asked the doctor what the infection rate was and much to my surprise, he said it was 3-5%, which is much lower than I thought it would be given the conditions. The emergency room was packed with hundreds of patients, and the space available was inadequate for the volume of patients. The amount of time people wait to be seen is unreal, especially given the conditions of where they are waiting. The patients are seen based on severity, as in the United States; however, most emergency rooms in the United States are blessed with air conditioning and adequate space for patients to wait comfortably. Visiting the hospital, along with house visits and clinics, was an invaluable learning experience.


During my experience in Nicaragua, I not only learned about a different culture but also about myself as a person and future professional. In personal reflection, I noticed an innate tendency to be somewhat close-minded about how medicine should be practiced. For instance, when a patient presented with insomnia, the physician prescribed Benadryl. I automatically disagreed with this decision because Benadryl, in my opinion, is not meant for helping people sleep but rather it is meant for people having an allergic reaction. I found myself so caught up in disagreement that it took me some reflection time to realize the reasoning behind why the physician prescribed Benadryl. It was the only medication available that she could prescribe the patient to relieve the patient’s symptoms; therefore, the physician made due with what was available. In the United States, we are privileged enough to have an abundance of medications available to us, whereas, in the areas we were serving, there was a very limited supply. As a future healthcare provider, I would hope that I can be more open-minded to things that may not be ideal to me and find ways to be frugal and make use of what I am blessed to have.


Aside from learning to have an open-mind, I learned several personal strengths that will make me not only a compassionate health care provider but also an overall, well-rounded person. For instance, my ability to recognize that patients with a different culture than my own may appear as though they do not care about their health, but in reality, are struggling to overcome barriers that prevent them from having adequate access to the services necessary. I would say another strength is my passion to understand the background of my patients and what they believe is important. It is important to me to make sure that my patients feel comfortable and can count on me to have their best interest in mind. In addition to cultural competence, I found myself able to easily solve medical problems by asking the right questions and observing the symptoms/vitals a patient had. I did not realize how much I have learned over the past several years through my education and work experience.


Some key takeaways from this experience that I would like to put into practice in the future are that cultural competence is an ongoing process, requiring much time, effort and persistence. The ability to adapt and accommodate when exposed to various cultures is an essential quality that every health care provider should have to provide the best care possible for their patients. Carefully respecting the views, beliefs, and lifestyles of every patient are imperative into determining what treatment will work best for that patient. It was an experience that forever changed my life and how I now view the world. Unfortunately, as mentioned in Mountains Beyond Mountains, once one problem is solved, another arises. No matter what we accomplish, there will always be another issue. There is no end. So, I guess the solution is to do the best we can and continue to push for a better world. The Millennium Development Goals (MDGS) are the efforts being enforced to solve global poverty, hunger, disease, etc. Kidder, in Mountains Beyond Mountains, discusses these goals and how Farmer was completely committed to accomplishing these goals (Kidder 2013). Our agency, although not quite as extravagant as Farmer’s efforts, was able to help in some ways by providing advice and some medications. Even though the trip was short and the idea of short medical trips is often scrutinized, we did everything we could to help in the best way we knew we could (Decamp 2007). We are such a small piece of a much bigger plan. I am so grateful to the communities we were able to serve in Nicaragua, and I cannot wait to be able to do it again since there is still so much for me to experience and learn. I was confident in my decision to become a medical health provider before the trip, and now after the trip, I am even more confident in that decision. My passion is helping people in any way that I can. I am so thankful to have been blessed with this experience.



1. Bonder, Bette and Laura Martin. 2013. Culture In Clinical Care. 2nd ed. New Jersey: SLACK Incorporated.

2. Decamp, Matthew. 2007. Scrutinizing Global Short-Term Medical Outreach. Hastings Center Report 37(6): 21-23.

3. Kidder, Tracy. 2013. Mountains Beyond Mountains. New York: The Random House Publishing Group.

4. Sequeira M, Espinoza H, Amador JJ, Domingo G, Quintanilla M, and de los Santos T. 2011. The Nicaraguan Health System. Seattle, Washington: PATH.

5. Storti, Craig. 2001. The Art of Crossing Cultures. Intercultural Press.

Chunking Down the App Process – One step at a time

For those of you applying this cycle congratulations on making it to this point. Being ready to apply is a huge accomplishment in its own right, and something you should celebrate. The medical school application process is a daunting roller coaster fueled with excitement, doubt, fear, stress, worry, and hopefully triumph. I advise a systematic approach to the overall process, and counsel students to take it one step at a time. At this point, all of your energy should be focused on the primary application. Completing the primary app takes a lot of work, and chunking it down into sections will help you progress through it. Keep in mind that this is your pitch to medical schools on why they should want you as part of their incoming class. Use the AAMC Core Competencies for Entering Medical Students as a framework for crafting an application that clearly communicates your strengths as a successful future physician. Here is a brief list of things to keep in mind during the primary app process:

-Order and submit your transcripts now to AMCAS.

-Contact your letter writers and check in about their readiness to submit letters on your behalf, they should do this asap. If one of your writers can speak strongly about how your work demonstrates a core competency mentioned in the AAMC guide ask them to write about it in your LOR, and send them the link describing the core competencies.

-Get feedback and edit your personal statement, do not discount the importance of this essay. Your essay should do two things effectively: provide the reader with a sense of who you are as a person, and clearly communicate why you want to be a physician (with special consideration to your core values).

-For the activities section choose experiences that speak to the core competencies mentioned above, and think about what you learned from your participation in each one.

-Use the MSAR to refine your school list, and apply as broadly as possible based on your budget. Apply for a fee waiver to increase the number of schools you can afford to apply to.

-Two of the most common reasons applicants need to reapply is that they apply too late or they don’t apply to enough programs, so do your best to apply as early and as broadly as possible without sacrificing the quality of your application.

I’ll continue to post in more detail on these topics, as well as secondary application tips, interviewing advice, non-traditional student topics, and general comments on navigating the premed process. Please feel free to send me a direct message if you have specific questions, want feedback on your essay, or post a question below.

Top 5 Things to Know About Medical School Rankings

Do medical school rankings really matter? Do you have to go to a top medical school in order to accomplish your dreams?  Premedical students ask these questions often.  It’s really a subset of the larger question which is “How do I choose which medical schools to apply to?”   But back to the rankings.  In the internet age, information is ubiquitous and there’s always a new med school rank list being published by some authority. These rankings in turn make pre-medical students nervous and question whether or not they need to go to a top medical school.  Certainly, if you have the opportunity to attend a top medical school then hey, if you can afford it why not take it?  The real challenge comes when you have that acceptance letter from a top program but you have an acceptance letter and a nice financial package from a lower ranked program.   Here are a few things you should know before worrying too much.

1) Anybody Can Make a Rank List. This is very important to keep in mind when researching medical schools. If you are going to rely on a rank list, make sure it’s a credible one. Always review their ranking methodology. There are certain respected and reputable organizations that put a great deal of effort into their ranking systems, and these should be taking at greater face value. Still that is not to say that their systems are perfect, but if you are going to consider school ranks, make sure to choose a respected organization.

2) Not all rank lists rank the same things. Rank lists tend to focus on research, primary care, or opinion surveys. Depending on what is most important to you, be sure you are looking at a list that reflects that. For example, if you don’t care about research, you might not place so much weight on the research ranks. I do caution however that because premedical students usually are not certain about what specific field they will pursue, be open to research when starting medical school as something might pique your interest.

3) Patients don’t really care how your medical school ranked. It’s great to go to a top ranked place and that has MANY bonuses. But when it comes to direct patient interactions, your patients won’t really care where you went. To confirm this, I asked several people where their doctor went to medical school, and a whopping 0% knew the answer. I know, you’re reading this and saying well my doctor went to [Insert School Name]. Okay, you’re the exception, and you’re obviously more interested in medical schools because you are reading this blog. For the most part, your patients will only care that you know what you are doing and that you treat them well. Doctors don’t build their clientele by advertising where they got their MD, they do so by being excellent in their practice.

4) Doctors don’t really care how your medical school ranked. As a practicing physician now, I can tell you that doctors don’t ask each other where they went to medical school. As a matter of fact, the question that is typically asked is “Where did you do your training?” And by training we are referring to residency and fellowship, not medical school. Here’s what’s most important for premeds to understand. You get your MD or DO in medical school, BUT you become a doctor in residency. Nobody will let a fresh medical school graduate take care of them because in reality they don’t know how to practice medicine yet. Residency is where you get your clinical training and fellowship is a further specialization. When choosing a medical school, put more value on what residency programs can this help you get into, rather than how the medical school ranks. Then when it is time to choose a residency, you should pay a little more attention to the ranking systems then because that truly affects how strong of a clinician you will be.

5) The top medical schools are on top for a reason. Taking into consideration everything I have said above, there is some great value to be gained from using reliable rank lists.  Medical schools that consistently rank at the top of these list do so for a reason. There’s no denying that the top 10 are special in their own ways.  Their ability to repeatedly rank is in part a reflection of their culture to achieve excellence. Now, this matters!  Along my journey to become a board certified physician, I was able to train at a top program and that desire to be the best was very evident. In my personal opinion, you should always take ranking systems with a grain of salt. Your success is based more on you than the medical school you attend. However, you want to be at a place that has a culture which demonstrates they can help you to succeed. A medical school does not have to be on the top of the list to do that. I went to a school that wasn’t ranked too high, but I chose it because the students performed excellent, got among the best board scores in the country, and matched for residency very well.

Here’s my take home message, rankings can be helpful to a certain degree, but make sure you take more than that into consideration.  Perhaps most important is finding a school that matches students into their top residency choices. If you can find a reliable medical school rankings list based on that statistic, use that list!

So, to close this article, I’ll ask you a question and look forward to your answers.  Which factors do you take into consideration when you rank medical schools?  What are the things most important to you?

Social Determinants of Medical Education

When considering the barriers to medical education for minorities and low-income groups, it is quickly apparent that there is great overlap between these social determinants and the social determinants of health. Indeed, much discussion has centered on the role of social and economic factors in the context of healthcare (Marmot & Allen, 2014). Similarly, the externally-derived barriers that limit access to medical education have been heavily explored from this perspective, and there is value to considering other categorical divisions for these issues, as new insights may be gained. There are some splitting of hairs necessary to discuss socioeconomic status as separate from social networks, but perhaps a different method of categorizing will minimize such entanglements.

From a broad perspective, where categories can be simplified, the following categories should be considered. The first is the availability of means, commonly thought of in terms of currency, as being the simplest way to assess the availability of means to pursue opportunities. The second category is social connections. This includes family members, friends, teachers, mentors, employers, etc. Of course, it cannot be forgotten that there is a relationship between the community that one belongs to and the availability of means, and this relationship can become exquisitely complicated in individual circumstances.

Availability of means

The cost of tuition for medical education in the United States is extraordinarily high. This high cost is even more notable when compared to other developed nations, where the cost of education is borne by the taxpayer base, rather than by the individual student. Here, in the United States, the cost of tuition for medical school ranges from approximately $16,000 per year to approximately $60,000 per year. This is the cost of the tuition alone, and does not include expenses for the cost of living. Cost of living expenses also vary widely, depending on the city where the medical school is located. For example, the estimated cost of living for medical students at the University of Arkansas for Medical Sciences is $20,780, whereas the estimated cost of living for medical students at the University of California at San Francisco is $31,656. Additional factors can also play a role, such as whether or not a student has in-state status at publically supported medical schools.

There have been some efforts to reduce the barrier imposed by the cost of attendance. The availability of federal student loans, for example, ensure that United States citizens who are accepted into medical school in the United States can generally have access to the funds to pay for it. However, these loans are administered at interest rates that are relatively high, although lower than the loan rates available through most consumer loan mechanisms. There is some controversy over the effectiveness of loan programs in improving minority access to education (Long & Riley, 2007). Beyond loans, many medical schools are part of larger, state-sponsored university systems. These medical schools typically offer residents of the state to attend the school at a significant reduction in tuition. For public medical schools, the difference in tuition for in-state students as compared to out-of-state students can be nearly two-fold. However, even with this subsidization of medical education, in-state tuition can cost tens of thousands of dollars per year.

However, looking only at the direct cost of medical school, one fails to capture the larger barriers imposed by the limited availability of means. Acceptance into medical school requires a number of academic and experiential qualifications to be met. Beginning with the academic requirements, it is worth keeping in mind that there are great disparities in the United States regarding high school graduation rates amongst minority and low-income groups (Heckman & Lafontaine, 2010). In general, families of similar financial means live in the same neighborhoods, and subsequently, their children attend the same schools. In many areas, school funds are related to property taxes. As a result, regions where the majority of the population is wealthier have more funding, compared to areas where the majority of the population is low-income. This creates a fundamental differential in what resources are considered standard. For example, at present, there are school districts that provide an iPad to every student, while there are also school districts struggling to maintain an adequate supply of classroom textbooks. Of course, education is about far more than the cost of the provided resources, and the value of an educator cannot be understated. However, teacher salaries also vary significantly across school districts. This, in turn, leads to a differential in educators as well. This is not to say that there are not many exemplary educators in low-income school districts, but it warrants acknowledgment that even a subtle differential can lead to significant consequences on a larger scale.

Therefore, before yet considering the impact of social connections, it is important to highlight that there are broad, system-level barriers affecting minority groups and those raised in low-income households.

The impact of social connections

It would be exceedingly difficult to overstate the importance of social connections, and the impact that they have on medical school matriculation rates. Children begin developing dreams and aspirations from a very young age. Indeed, it seems that perhaps the only limit to a child’s imagination is the breadth of their experience; therein lies the problem. Children that are exposed to professionals outside of a professional context (that is, a child that knows a doctor as a family friend, and not merely as the scary person with a white coat) have the concept that this profession is a real and viable option for them to pursue. This may not be the case for children who only meet the doctor in the doctor’s office.

There is also much to be said for the importance of family support. Familial networks that are fundamentally supportive in nature will encourage children to work towards dreams and aspirations, even if those aspirations are difficult to achieve. Alternatively, if the family environment is one in which such goals are scoffed at, a child will quickly become discouraged and choose to pursue more socially acceptable goals.

The process of pursuing post-secondary education can be overwhelming. The cost of applications alone can dissuade students. While there are fee waivers available, they require additional paperwork that is yet another barrier. Students who are surrounded by others going through this process have the benefit of peer support, which can also influence academic performance (Zimmerman, 2003). However, students who do not have peers or role models assisting them often drop out of the educational training pipeline at this juncture. Many schools employ counselors exclusively for the task of guiding students, but the utilization and quality of these resources vary greatly from school to school.

For students who overcome the aforementioned aspirational barriers, experiential barriers may still remain. Acceptance into college, and especially acceptance into medical school, require applicants to have pursued a certain set of baseline experiences, most often emphasizing community service. Students who have a rich social network are aware of this and can prepare accordingly. However, students lacking informal information resources may not realize that these non-curricular requirements exist, and may struggle to prepare a competitive application as a result.

Finally, the importance of developing social connections with mentors is essential. These mentors not only advise students but also endorse them through letters of recommendation. Depending on the social norms that a child is raised in, developing any type of personal rapport with an instructor may seem odd or even disrespectful. Yet this, once again, could serve as a barrier. A strong letter of recommendation can explain and even supersede a lack of experience or lapses in academic performance. But a recommendation letter of this sort would rely on there being a connection between the student and the mentor that exceeds the standard relationship.

The intersection of means and social connections

While the main focus here is on the consideration of broad categories of barriers with less overlap than those typically considered, it is important to still address the intersection of financial means and social connections. For this, two scenarios will be presented.

First, there are the students who overcome all aspirational and support barriers, yet social responsibilities are forced to take priority. For example, there are many students who must work full-time, even at the cost of ceasing their academic pursuits, in order to take care of their families. In this case, the financial resource systems designed to aid in the accessibility of medical education are insufficient. As discussed, the financial resources available involve loans and reducing the cost of tuition. However, neither of these mechanisms would help the student to fulfill their family obligations.

The second scenario is systemic in nature and related to the differential in opportunities provided by various school districts and education systems. As discussed above, there are a number of non-curricular, experiential requirements for post-secondary education as well as medical education. School districts with a greater availability of resources often organize opportunities for their students that meet these requirements. For example, volunteering opportunities around the community, and supplemental training that is outside of the formal coursework. Students from school districts with fewer resources likely need this assistance more to reduce barriers, but in the absence of sufficient resources, the point is simply unfeasible.

Using availability of means and social connections to reduce barriers to medical education

While it is clearly impossible to truly generate categories of barriers that are independent of one another, this perspective of the barriers to medical education is helpful from the perspective of implementation. To begin, a stronger education system nationwide is needed, but of equal importance are mechanisms needed to equalize the opportunities provided through education. Particularly when considering public education, resource re-allocation (though controversial) can significantly offset many of the opportunity barriers discussed here. There are many organizations and institutions that strive to help students through career and academic planning. Many of these resources are very good, however, they exist independently from one another. Some efforts have been made to aggregate these resources, but it is often still unintuitive and difficult to navigate without assistance. Improved promotion of and user interfaces for these resources would make them far more effective.

The fundamental cost of higher education, including medical education, must also be addressed. College tuition rates are ever increasing as the demand for non-curricular opportunities puts pressure on colleges and universities to spend increasing amounts of money on non-academic topics. Therefore, the cost of these additional programs must first be addressed. Additionally, the financial responsibilities of higher education should be considered separately from the perspective of social benefit. Increasing the educational level of a population also increases the quality of life in that population. While specific estimates on the ultimate size of the economic benefits from socially funding higher education are controversial, it is broadly accepted that this effect exists. In regards to medical education specifically, both the social value of a strong healthcare system and the economic benefits of a healthier population are great.

There is evidence that indicates that the diversity of healthcare providers has an effect on the extent to which patient populations pursue care (Komaromy et al., 1996). Therefore, as an increasing portion of the United States population is comprised of minority groups, the health of our overall population relies upon improving the diversity of our healthcare providers. Reducing barriers to medical education not only reduces barriers to education as a whole but also improves the health of the population. The need for these solutions are both social and economic in nature and therefore warrant broad support.


1. Heckman, J. J., & Lafontaine, P. A. (2010). The American high school graduation rate: trends and levels. Rev Econ Stat, 92(2), 244–262.

2. Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., & Bindman, A. B. (1996). The role of black and Hispanic physicians in providing health care for underserved populations. The New England Journal of Medicine, 334(20), 1305–10.

3. Long, B. T., & Riley, E. (2007). Financial Aid: A Broken Bridge to College Access? Harvard Educational Review, 77(1), 39–63.

4. Marmot, M., & Allen, J. J. (2014). Social determinants of health equity. American Journal of Public Health, 104(SUPPL. 4), 517–519.

5. Zimmerman, D. J. (2003). Peer Effects in Academic Outcomes: Evidence from a Natural Experiment. Review of Economics and Statistics, 85(1), 9–23. 



Not recently active