10/23/2014 10:40 pm ET Updated Dec 23, 2014

Dare to Be 100: Stanford MDs 2018

Every year about this time in the fall a bunch of us Stanford medical types get together to evaluate potential med school applicants. Physicians, surgeons, nurses, students, and other assorted folk assemble to spend hours interviewing each of these brightest and best who had just flown in from all over just to have us look them over.

Essentially the process is impossible, or nearly so. We receive 7,500 applicants for 90 slots. We interview 400, from whom 140 are selected. 90 will eventually matriculate. So by the time we get to interview the candidates they have already passed through major filters.

Our process is interesting. Ten candidates are grouped, all nervous. They are in turn met by 10 interviewers, singly in examining rooms. At a bell they are instructed to read a brief paragraph on the outside of the entering door containing a short but complex and usually ambiguous case scenario. Sample: A 30-year-old male with obvious paranoid symptoms is refusing to take his medicines prescribed for him by his psychiatrist. How will you advise him?

There's clearly no right answer to this question which is intentionally chosen to reflect complexity and uncertainty which are just those qualities which the standard medical encounter presents.

Or you are a department store customer and see a woman take something off the rack and put it in her shopping bag. What will you do? Once again complex, uncertain, and ambiguous.
The applicants are given two minutes to review the problem, and then they enter the room and have 8 minutes to discuss this scenario with us. It is an intense eight minutes both for the examiner and examinee. By the time we are through our process of 10 students we are instructed to score them on a scale of 1 to 10. Of 10 applicants I rarely give a 10, an occasional nine, a few eights, but mostly sixes and sevens, only a rare five or below.

The genders are about even, most come from prestigious colleges, Harvard most commonly, but with Yale, Stanford, MIT, UCSF among our brilliant group. Only one from my home college of Williams. I gave him an eight, I seem to recall.

Virtually all groups are smarter than hell, (clearly sharper than I), and most seem idealistic. I hope this sustains.

Many are seeking the double M.D., Ph.D. degree program that is intentionally tilted towards a research career. I'm personally much more committed to grading from a general medical practice position than for research potential. Still Stanford is known for its technical brilliance. Many Nobel prizes are evident. So this process is skewed, but I simply try to grade my candidate on whether I might want them to be my doctor when I have a bellyache at 2 a.m. years from now. Medicine at its heart is a complex, uncertain, and ambiguous enterprise, exactly the parameters that this type of interview is designed to process. The interview is slated to be as objective as possible limiting the inevitable subjective elements that are intrinsic to any interpersonal encounter.

This process of examining a candidate is capricious. Last week I was just finishing my roster of 10 and was remarking to my co-examiner how outstanding I thought they were. She, in turn, said that from her perspective how weak they were. Such a different evaluation can only partially be explained by the different case scenarios. But hopefully through this process the very best of the best are finally selected.

I am personally proud to be part of this basic process which is destined to select the Stanford M.D. graduates of 2018.

I relish the memories of my graduation from the country's oldest medical school, the University of Pennsylvania School of Medicine, class of 1955, seemingly centuries ago, but really only yesterday. The mission endures.