The Preclinical Years

The Preclinical Years

Michael Englesbe

Christopher J. Sonnenday


Students entering medical school demand a diverse and inclusive community. Diversity and inclusion have been a social norm within their lives. They have witnessed a black president in the United States as well as female world leaders. Many have traveled extensively, and all are in touch with broad communities through technology. Students view diversity well beyond just race; they view it as the complex milieu of backgrounds, experiences, and perspectives within a team. Thoughtful leaders call this “cognitive diversity.”

Preclinical students have been educated in teams and are well aware that diversity is a key aspect for successful teams. Students enter medical school with an expectation that their differences will be appreciated and celebrated. They do not expect to have to hide these differences. They expect to be heard.

Entry into medical school is more competitive than ever. Acceptance rates at many medical schools are less than 5%, and the majority of students who apply to medical school are not admitted to any schools.1 It is increasingly rare for medical students to enter medical school immediately upon completion of an undergraduate degree. For example, at the University of Michigan, less than 20% of students enter immediately following college. Students expect to take several “gap years” to solidify their
personal narrative and decision-making. The average student has 3 years of professional experience. During this time, students most commonly work in biomedical research, technology, service organizations, or entrepreneurial endeavors. These organizations frequently have very informal and flat organizational structures. Young students are used to calling the professors and their bosses by their first name, they are used to freely voicing their opinions and beliefs, and they have an expectation that they’ll be treated with civility and judged by their thoughts and actions.

The educational experience is more student-centered than in previous generations. Students are taught to consider their unique gifts. They are purpose-driven, seeking meaningful work that is impactful beyond themselves. Entry into competitive medical schools requires that students demonstrate self-reflection. Students have experience identifying their strengths and communicating their core values. Students expect to do meaningful work. They are keenly aware of the importance of belonging within a community. They have specific skills on how to act within a community and with this, value inclusion. Students aspire to deeply improve the world. They are committed to being “givers,” focusing on their contributions. The medical school admissions team at most institutions has deep experience in building a talented and diverse class.


Students demand more than ever; surgery must meet these demands or the discipline will not flourish. More importantly, the field will fail to meet the growing needs of society. Students are better suited to serve as surgeons than ever. They have had deeper and more diverse experiences, are more focused on service, understand technology, and are willing to work hard (when there is a reason). Attracting them to surgery requires that surgical culture and curricula are respectful of their previous experiences.

Intentional effort is needed to engage preclinical students in surgery. Early exposure to surgeons can have a profound impact on career choice. Within this context, students need to be able to see themselves as able to thrive within surgery. Preclinical students are likely to value diversity and inclusion more than older members of clinical care teams.


Cultivating engagement in surgery by preclinical medical students requires an intentional curriculum. The curriculum should create an approachable opportunity for students with a passion for surgery. A small and diverse cohort of faculty should be given responsibility (and credit) to run this group. The operations of this group need to be supported by administrative staff, and departmental leadership should generously fund this effort. A diverse and excellent group of senior students should set the agenda and organize and lead activities. These activities should include opportunities for networking, outreach, and research.

Diverse student leadership is key to the success of these efforts. Current upper-level students will be most attentive to the needs of preclinical medical students. Discretionary time during the preclinical curriculum can be relatively scarce for some students, and the opportunities must be designed to optimize
student engagement and thus integrate with the day-to-day demands of the preclinical medical school curriculum. The program should include opportunities for technical skill development, leadership training, and research. Trainees and faculty should talk frankly about career development and personal wellness. Preclinical students are as interested in what the attending surgeon did on the weekend as they are with what the attending surgeon did in the operating room or clinic on Monday (Figure 12.1).


Engage With High School Students

The Doctors of Tomorrow program (University of Michigan, 2019) inspires and prepares high school students from underrepresented communities to successfully pursue careers in health care in order to increase diversity among medical professionals. The students are carefully selected from a magnet high school in Detroit, Michigan. Students come to the University of Michigan for a longitudinal program of clinical immersion, academic preparation, and leadership development coupled with continued engagement and mentorship throughout high school and beyond. The program creates an educational experience where all participants are actively engaged in developing and promoting cultural awareness to reduce bias in the medical field. This program is overseen by a surgeon. All members of the department can participate in this program, creating a virtuous community of impact and inclusion. These talented young students come to the clinic, they spend time in the simulation lab, and they become familiar with surgical staff and equipment. They are exposed to nurses, house officers, and surgeons. They are able to ask questions about all aspects of a surgeon’s life. This program has significant spillover
benefits for participants, solidifying the mission around education, diversity, and service. This program was initially funded by the Department of Surgery but is now sustained through philanthropy.

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May 5, 2022 | Posted by in GENERAL SURGERY | Comments Off on The Preclinical Years

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