How to Choose the Right Extracurricular Activities for Medical School
/Learn what looks good on medical school applications, what counts as various extracurricular activities, and how many hours you need
Part 1: Introduction
Part 2: Extracurricular activities for medical school: what you need to participate in
Part 3: How to think about research as a premed
Part 4: How to pursue extracurriculars for medical school the right way
Part 5: Considerations for international students
Part 6: Navigating extracurriculars as a non-traditional student
Part 7: Med school extracurriculars Q&A with a former Harvard Med School adcom
Part 8: Frequently asked questions about extracurriculars for medical school
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Part 1: Introduction
While browsing premed Reddit to better understand what medical school applicants are most concerned about, we came across the following question:
“How can I stand out on my medical school application if I’m not one of those gunners?”
We laughed, not at the student’s confusion about how to outshine the competition, but at their use of the word “gunner.”
While this was the first time we had seen the word, we knew exactly what type of student they were referring to:
The ones who are part of nearly every single premed club on campus
The ones who seem to be shadowing, volunteering, conducting research, or doing some other humanitarian work at all hours of the day
We’ve all met students like that.
And while their accomplishments are impressive, comparing yourself with them can make you feel average. Consequently, you feel stressed out and behind.
How could you compete with them? Do you even want to?
On the other hand, if you are a superstar premed student, you might be wondering whether you're optimizing your time by pursuing the “best” extracurricular activities for medical school.
You're conducting research, shadowing a doctor, and volunteering, but are you getting enough hours of each? Are you missing anything critical?
These are incredibly important questions to ask no matter which school tier you're primarily applying to, and even more so if you're aiming for a top-10 program.
In this guide, we’ll go over the extracurricular activities that you should participate in during your premed years, including how many hours of each you’ll want to rack up in order to be a competitive applicant. We’ll also help you understand how to strategically pick and choose your extracurricular activities so that you can stand out from the pack when applying to med school.
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Part 2: Extracurricular activities for medical school: what you need to participate in
Imagine you could know exactly where to focus your time during college to maximize your odds of getting into medical school.
If you had that information, you could spend less time on extracurricular activities you don’t love, and more on the ones you do. Fortunately, this information is available to you.
For years, the University of Utah School of Medicine provided their specific extracurricular recommendations, including the minimum number of volunteer, shadowing, and patient exposure hours applicants needed to obtain, as well as what they looked for in leadership and research activities.
While Utah no longer provides applicants with specific numbers of extracurricular hours needed, we found their past recommendations so helpful that we applied them to create the guidelines below.
Below, you’ll find three guidelines for the number of hours you should complete in each extracurricular category: the absolute minimum requirement, what it takes to be competitive, plus our recommendation to help you apply to medical schools the right way.
(Note: Before we list our recommended hours across various extracurricular activity categories, we want to emphasize that the number of hours you devote to each is just one variable that adcoms consider. In addition to hours, med schools evaluate your length of commitment, impact, and achievement within each extracurricular category, as well as the cohesion of your experiences across categories. We’ve provided guidance on how to secure cohesive experiences later in this guide.)
How many volunteer hours you need for medical school will depend on a number of factors, from what type of volunteering you do to whether you intend to take a gap year.
Community/volunteer service
Description: “Involvement in a service activity without constraint or guarantee of reward or compensation.”
Minimum requirement: 100 hours within the last 4 years
To be competitive: 300+ hours within the last 4 years
Our recommendation: 500+ hours within the last 4 years
Physician shadowing
Definition: “The observation of a physician as that individual cares for and treats patients and carries out the other responsibilities of a medical practice.”
Minimum requirement: 30+ hours
To be competitive: 50+ hours
Our recommendation: 100+ hours
It’s ideal—although not required—that you shadow physicians across two or three specialties (e.g., primary care, nephrology, dermatology, emergency medicine) and across two or three contexts (e.g., inpatient, outpatient, community clinic, operating room). That way, you can demonstrate to medical school admission committees that you’re familiar with the breadth of clinical practice.
(Suggested reading: How to Ask to Shadow a Doctor)
Patient exposure
Definition: “Direct interaction with patients and hands-on involvement in the care of conscious people in a healthcare-related environment, attending to their health maintenance, progression, or end of life needs.”
Minimum requirement: 100+ hours
To be competitive: 300+ hours
Our recommendation: 500+ hours
Keep in mind that time spent shadowing physicians and caring for friends and family don’t count towards patient exposure hours. Additionally, patient exposure doesn’t include administrative, housekeeping, or other types of indirect patient interactions, even when performed in a clinical setting.
Here is a list of common ways or settings in which you can gain patient exposure experiences:
Formal hospital volunteering experiences
Assisted living facility
Hospice care center
Home health
Rehabilitation centers
Crisis text line
Suicide hotline
What about becoming a medical scribe? While scribing is a very popular premed activity, it falls somewhere between patient exposure and shadowing. If you’re missing patient exposure hours, we discourage you from relying exclusively on scribing to fill that gap and encourage you to also pursue direct patient care experiences.
Leadership
Definition: “A position of responsibility for others, with a purpose to guide or direct others.”
Minimum requirement: 1+ leadership experience lasting 3 months within the last 4 years
To be competitive: 3+ different leadership experiences, each lasting 3 months, within the last 4 years
Our recommendation: Same as the “competitive” recommendation above
Leadership is not limited to officer positions in clubs or formal titles. Medical school admissions committees more so care about your demonstration of leadership, whether by taking on increasing responsibilities in a research lab, leading a new initiative through community service organizations, etc.
Research
Definition: “Involvement in a scholarly or scientific hypothesis investigation that is supervised by an individual with verifiable research credentials.”
Minimum requirement: “Participation in hypothesis-based research,” whether as “part of a class where you answered or tested a hypothesis and received a grade.”
To be competitive: “[Completion of] hypothesis-based research outside of the classroom that is supervised by an individual with verifiable research credentials, [including] independent research or senior thesis.”
Our recommendation: 1+ year of research in the same lab
Because we receive more questions about research than any other extracurricular category, we’ll address some of students’ most common research-related concerns in the next section.
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Part 3: How to think about research as a premed
How important is research for medical school?
The importance of research for med school admissions varies from program to program.
Generally speaking, MD programs tend to value and expect significant research experience more so than DO programs. Of course, there’s a lot of variance, with some MD programs expecting more research experience than others, and the same is true for DO programs.
Some students try to categorize certain medical schools—especially highly ranked schools—as “research-focused,” and others as “clinical-focused” or “service-focused.” This approach and thinking are misguided, since all medical schools value research experience.
That’s why we strongly recommend that you obtain significant research experience during your undergrad years in order to maximize your odds of admission, even if you intend to work full-time as a clinical physician throughout your career.
Of course, if you’re applying to MD/PhD programs, research should be one of your strongest extracurricular areas, if not the strongest. While there is no specific cutoff with respect to the number of research hours you should accumulate, successful MD/PhD applicants typically have well over 1000 research hours, often across more than one lab.
How important are research publications for getting into medical school?
We often receive questions from students who are interested in contributing to publications but don’t know how to get involved as part of their research experience. The truth is that whether you receive a publication credit as an undergraduate largely depends on the culture of your particular lab.
In some labs, only senior researchers are credited, whereas in other labs students and assistants may be included as well. To get a sense of whether a lab has a culture of sharing authorship, check what publications have come out of that lab and what positions are held by the names on those publications. If you’re an undergraduate student, look for labs that list publications that include undergraduate student names. (Note: If the publication list is not on the lab website, review the PI’s CV.) Typically, labs will have a “People” or “Members” section that you can use to cross-reference names.
In most cases, you shouldn’t expect to receive publication credit. However, once you are working in a lab, you can humbly mention your interest in publishing, offering to contribute to the lab at a higher level, such as through data analysis, manuscript preparation, etc.
A better approach is to say you are interested in progressing to a point in the lab where you can take ownership of a project and ultimately make a meaningful contribution to the research community. You could also say that you hope to gain experience with all elements of the research project, from project conceptualization to statistics to writing, with the ultimate goal of having a completed published project to share.
How to find summer research opportunities
Getting involved with research during the academic year is usually straightforward as most universities have a variety of opportunities for undergraduates, from course-based research to student employment as a research assistant.
You might also be interested in pursuing research over the summer for any number of reasons, such as gaining more experience, wanting to work in a different field, or having more time in the summer to do research than in the academic year.
But how do you find summer research opportunities?
Summer research opportunities typically fall into the following categories:
Formal summer research programs
Pharmaceutical internships
Informal research opportunities
Formal summer research programs: Many universities hold formal research programs over the summer that allow students to gain experience within a structured environment. Benefits to formal programs include a developed infrastructure, the possibilities for a stipend, and extra programming like lectures or professional development workshops.
On the other hand, many formal programs have a set focus (e.g., neuroscience) or a specific research project, so you’ll want to make sure that your interests align with a program’s focus. Formal programs can also be competitive, and they require you to spend time putting together application materials, including letters of recommendation.
To find summer research programs, first check to see what’s available at your university. We also recommend searching online according to your area of interest (e.g., “neuroscience summer research programs”).
Pharmaceutical internships: Another option includes pharmaceutical companies, many of which have summer internship programs for undergrads. These programs typically have pre-defined projects that end with a capstone presentation. Like university-based research programs, pharmaceutical internships are frequently competitive but often come with stipends and other perks.
Informal research opportunities: You can also reach out to individual researchers at your university—PIs, or even graduate student TAs who you may have worked with—to learn more about their labs and whether they are in need of assistance over the summer. Because most PIs understandably appreciate free labor, there’s a good chance you can find an opportunity this way.
While informal research opportunities will be less structured, less competitive, and unlikely to pay you, they usually offer greater flexibility, plus the potential to continue working in the same lab after the summer is over. This continuity might allow you to play a more impactful role in the lab’s projects or to develop a deeper relationship with a mentor who could potentially write you a med school letter of recommendation. You might even be able to receive university credit for your work.
Informal opportunities enable you to better pick and choose what you want to work on, so they tend to be our recommendation for students looking to develop a specific theme in their medical school applications. However, if a formal research program aligns with your interests, that is an excellent choice as well.
(Suggested reading: How to Write a Great Research Assistant Cover Letter)
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Part 4: How to pursue extracurriculars for medical school the right way
University of Utah used to explicitly state that applicants must meet the minimum requirement in all seven areas they evaluated (the five extracurricular areas listed above, plus GPA and MCAT score), and be average or above average in at least five of them to be considered for admissions.
And while other schools’ admissions committees haven’t revealed their specific thresholds, several adcom members have confirmed to us that they basically follow the same rubric, with slightly higher or lower thresholds depending on their level of competitiveness.
Regardless, these requirements clearly make the point that you don’t have to be extraordinary in every single area of your admissions profile. In fact, most of the very best applicants aren’t.
(Note: This doesn’t mean you can forgo strong grades and MCAT scores, which are the foundation of a competitive medical school application. However, this guide focuses on what to do beyond achieving high stats to stand out.)
(Suggested reading: Medical School Requirements: The Definitive Guide)
Strategies for selecting extracurricular activities for medical school
As a premed student, one of the greatest challenges you face when considering various extracurricular activities is having too many choices.
There are more clubs, service opportunities, and research labs than you can get involved in during an entire lifetime. It also seems like your premed peers who have already made some decisions on what to pursue know something you don’t.
This overwhelming choice and tendency to compare ourselves to others leads to frantic decision making. You may find yourself joining too many organizations, doing work you’re not excited about, and barely moving the needle on bolstering your overall admissions profile.
If you’re unsure what extracurriculars you’d like to focus on, you probably have a “filtering problem.” Here are two examples of what we mean:
Imagine walking into a supermarket with no idea what you’d like to cook for dinner that evening. You’ll wander aimlessly, feel stressed about your decision, make impulse buys, and leave frustrated. On the other hand, if you arrive at the store with a specific recipe, you’ll have clarity, spend less time, and feel excited about your meal.
Say you were gearing up to travel, yet you had no specific destination, preference for number of stops, travel dates, or budget in mind. You would have an extremely difficult time purchasing a ticket. On the flip side, if you were going to visit your grandmother, who lives outside of Philadelphia, around Thanksgiving, you’d have a much easier time making decisions. In the latter scenario, if you saw a great deal for a London flight during Thanksgiving weekend, it wouldn’t matter because, well, your grandmother doesn’t live in London.
Both of these examples highlight the benefit of having a “filter” when making decisions. Without a proper filter, it’s like walking into a supermarket with no plans and ending up with a random set of items that won’t lead to a delicious dinner.
So, how can you develop a clear filter? When selecting extracurricular activities for medical school, we advise students to first answer the following two guiding questions:
What population do you want to primarily serve? You can define “population” however you please, whether based on gender, race/ethnicity, socioeconomic status, medical or other condition, geography, or a combination of these other factors. For instance, you could focus on…
“parents”;
“parents of children under 5”;
“parents of children under 5 with autism spectrum disorder”;
“parents of children under 5 with autism spectrum disorder whose earnings place them below the poverty line”; or
“parents of children under 5 with autism spectrum disorder whose earnings place them below the poverty line and who identify as Latino or Latina.”
This example demonstrates how you can incorporate as many variables as you would like to identify your primary population of interest. The more specific you get, the better filter you will have, even if fewer total people fall within the group.
We recommend starting more specific and branching out from there over time as you gain a strong foothold in your chosen activities. Moreover, we want to emphasize that including a clinical condition or a medical specialty is not necessary when identifying a population.
What problem do you want to primarily solve? Once again, you can define a problem however you please. For instance, the problem could be…
“social isolation”
“food insecurity”
“insecure attachment”
“late identification and treatment”
“lack of culturally competent care”
And so on. At this stage, don’t worry about how you are going to address the problem; that will come later.
In addition, don’t conflate the population with the problem. For example, if your identified population is “people with diabetes” your identified problem need not just be “diabetes.” Getting more specific will help you identify the right extracurricular opportunities moving forward.
Once you have keyed in on your population and problem of interest, you can apply your filter when evaluating extracurricular opportunities.
Let’s say that your population and problem of interest is “assisting parents of children under 5 with autism spectrum disorder with securing an accurate diagnosis and ongoing intervention.”
If you were to come across a great research opportunity in a lab that studies leukemia, you could much more easily turn it down. On the flip side, you would jump at the opportunity to join a lab that studies how to improve diagnostic accuracy for autism, a service experience dedicated to connecting parents with accessible and ongoing autism treatment, etc.
Collectively, a filter can help you effectively search for well-fitting opportunities, turn down misaligned opportunities, and build a cohesive theme rather than looking like most premed students who appear well-rounded but have no clear focus or theme.
For the remainder of this section, we’ll cover additional best practices for choosing extracurricular activities for medical school, and we’ll show you how to use those guiding questions to think through each strategy.
As we go through these strategies, let’s stick with a population many premed students identify—individuals who are in some way underrepresented or marginalized—and that you’d like to address an issue that many others do: healthcare disparities.
Strategy #1: Choose depth over breadth
There’s a select group of premed students with major achievements, whether publishing their research in a famous journal, founding an organization that provides food and health education to needy families in their community, or launching a widely-used health care app. These students end up getting into the very best medical schools.
Sound hard? It’s supposed to be.
Oftentimes, we look for shortcuts to achieve things that require years of hard work.
For example, we all want to publish our research in a famous journal. However, we don’t want to spend evenings or summers in lab on countless failed experiments before making a big discovery.
We also want to run an organization on our own terms, to make the type of impact we want to make, and to get the media coverage we feel we deserve. However, we’re less into the process of recruiting the right individuals to help us or building the necessary relationships and collaborations to produce large-scale changes.
Nevertheless, regardless of your goals, you have to put in the time to do something meaningful if you want to make your medical school application stand out.
At this point, you might be thinking that you don’t really have the time to achieve something extraordinary, given your course load, extracurricular activities, and desire to maintain some semblance of work-life balance. Unfortunately, your biggest competitors are pushing the envelope with their activities.
Given that we all have 24 hours in a day, how is it that some people tend to produce more in the same amount of time? Is it because they give up their social lives? Is it because they’re just so much smarter?
Not really. Rather, the most impressive medical school applicants focus on fewer things and go deeper with each one. This is exactly what you should do to stand out.
How to apply the guiding questions:
Remember that in our example scenario, you’d like to work amongst underrepresented groups of people who are impacted by healthcare disparities. Choose one or two areas–such as people of color or people with disabilities–and think of how you can immerse yourself in areas that will allow you to work to solve problems those groups often face. Maybe this means going to areas of town that are predominantly populated by people of color to seek opportunities. Working as a caretaker for someone who has physical disabilities will help familiarize you with the everyday challenges facing people with these difficulties.
Strategy #2: Aim for experiences that provide a meaningful learning experience
As you think through possibilities for extracurricular activities, focus on those that will provide you with meaningful learning experiences. While it’s important to explore things that interest you, this isn’t just a time to have fun like when you were in high school. You are preparing for medical school, which means the activities you choose should have some relevance and, ideally, help develop the skills you will need. The activities you engage in should complement what you’re learning in school in some way.
That said, there are many things you can learn through extracurricular activities. Depending on the activity, you might have the opportunity to learn important problem-solving skills, too, which will come in handy both in medical school and in the professional working world. You’re also likely to develop time management and critical thinking skills simply by participating in extracurricular activities while in college.
How to apply the guiding questions:
Ask yourself what you hope to learn by working with the populations you wish to serve, and then think of what you might learn as you work to solve a problem. Using the previous example of someone who wishes to work with underrepresented groups, think about some of the problems facing those people. Then, spend time learning more about those problems. Once you’re working with that population, you’ll have something to draw on which will help you get more out of your experience. In addition, think about what problems you hope to help solve for that population, then consider what you could learn as you work to resolve a bigger problem.
Strategy #3: Select something you're passionate about
It goes without saying that when you're excited about something, you’ll be more motivated to participate in it and you’ll be more likely to learn from it. As it applies to choosing extracurriculars for medical school, you’ll want to select activities that you’re enthusiastic about, if for no other reason than you’ll be spending a lot of time immersed in those activities.
Sometimes students choose activities that they think will look good on their application, despite the fact that those activities bore them to tears. With so many options for extracurriculars available, there’s no reason for you to choose something you find dreadful.
How to apply the guiding questions:
For this strategy, think about how you can serve the populations you’d like to serve while at the same time exploring something you enjoy. Using the example we’ve been using, consider how you might be able to work with underserved populations by doing something that excites you. Maybe you’d like to work as a volunteer EMT, so you’d decide to serve in a community that is disadvantaged. As you consider problems you’d like to resolve, think about issues that those communities face and how your passions can drive your decisions about what you do. If research is something you enjoy, think of some topics you can delve into that will provide insights into the issues those communities face and ways you might go about coming up with solutions for that population.
Strategy #4: Consider ways you might demonstrate leadership in an extracurricular activity
There are plenty of varied opportunities for premeds to work in clinical settings and with underserved patient populations. If you’re passionate about making a real difference in people’s lives, think through the ways you might bring your ideas to the forefront when pursuing a particular activity. Finding a way to stand out on the job can showcase your leadership skills and help you stand out on your med school applications.
How to apply the guiding questions
For example, maybe you know that you want to work with a disadvantaged urban population in your city and you’ve identified a community clinic where you think your talents could be put to good use. This clinic likely has outreach programs that could range from counseling for substance abuse to vaccinations or free screenings for certain diseases.
Outreach programs such as these tend to be understaffed and knowledge of these services is sometimes poorly disseminated among the community. This could be a chance for you to take the lead and make a positive impact on the clinic as well as patients.
This is just one hypothetical possibility, but many extracurricular activities could be harboring a fantastic leadership opportunity where you can leave your mark.
Strategy #5: Networking in extracurricular activities
Engaging in extracurricular activities provides numerous opportunities to build meaningful connections that can significantly enhance your medical school application and future career. Therefore, while choosing extracurriculars you’re passionate about and that have you working with a population you’d like to serve as a physician, it’s worth considering who else you’ll be working with and how you can make connections while involved in your activities.
Participating in clubs, volunteer organizations, or research projects allows you to meet like-minded individuals and experienced professionals. These interactions can lead to mentorship opportunities, where seasoned practitioners can offer guidance, share insights about the medical field, and help you navigate your career path. Establishing these relationships early can be invaluable as you seek letters of recommendation or advice on medical school applications.
How to apply the guiding questions
In our example above, you’re interested in working with underserved populations. There are quite a few medical schools that seek students interested in working with these populations since this is a key group they serve themselves.
Perhaps the organization or club you’re interested in joining has connections to one of these schools or the physician leading your team is an alumnus of a school that focuses on serving them.
While you’re spending your time in this activity, don’t forget the importance of building relationships with people who could be future colleagues or who may be able to give you crucial advice when you most need it.
Strategy #6: Premed superstars choose an area of specialty
To reiterate, University of Utah School of Medicine used to explicitly require applicants to “achieve at least the minimum level of performance in all seven areas [that they evaluate] and be average or above in five out of the seven areas in order to be eligible for further consideration.”
If you’re reading this guide, you’re probably less interested in becoming “eligible for further consideration” and more interested in being seen as a star applicant and getting into medical school.
To make that happen, you have to become really good in one—maybe two—of the five areas outside of GPA and MCAT scores.
Just like our society relies on people to develop different areas of expertise, medical schools want to ensure that various specialties are represented in their student bodies. In other words: medical schools don’t want well-rounded students; they want well-rounded student bodies, ones comprising a collection of specialists (i.e., premed superstars).
The specific area you choose to become a superstar in is entirely up to you and should depend on your genuine interests. That way, you’ll be willing to put in the effort to make it happen. Moreover, by focusing on fewer things, you’ll inevitably reduce your stress.
As an added bonus, securing premed superstar status brings with it a ton of material to write a great medical school personal statement, AMCAS Work and Activities section, and secondary essays, as well as discussion points for your medical school admission interviews, whether traditional or MMI.
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How to apply the guiding questions:
As we mentioned above, you should focus on an area of interest to you. However, premed superstars become devoted to at least one specific area and they make that their domain. Working through the guiding questions, you should ask yourself how you can hone in on a specific area that revolves around the populations you’d like to serve while also helping to resolve issues you see in healthcare.
Continuing with the example we’ve been using, you might think about how you can shine for underrepresented populations, choose one (possibly two) specific areas that are a problem for them, and dedicate yourself to helping solve that problem. Maybe you decide to focus on the fact that income often restricts minority populations by working in a clinic operating a sliding scale payment structure. Or, perhaps you would like to give your attention to the way in which social factors impact health equity. Whatever your cause, dive deep into it to the point where you become “known” for focusing on that area.
Once you’ve chosen the area in which you want to develop your specialty, you’ll have to go beyond what most students do, one small step at a time. For example:
If you’ve chosen research, ask your PI whether they’re open to you pursuing an independent project under their mentorship.
If you’ve chosen volunteering, consider what problem you want to solve, and for whom. Then, ask your peers and local community organizations for help to make it happen.
If you’ve chosen patient exposure, brainstorm ways you can improve patients’ experience while in the hospital. Perhaps you can organize a fun event for patients or greet them in a special way.
The options are endless, but the end result is often the same: multiple acceptances to prestigious medical schools.
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Part 5: Considerations for international students*
*This guidance should be used for educational purposes only. Nothing about this guidance should be construed or relied upon as legal advice. If you have questions about visa requirements or work authorization, you should contact a licensed immigration attorney.
As an international student, you’ll have to account for additional considerations when choosing extracurricular activities for medical school. For instance, it can be challenging for any student to secure a position shadowing a physician but, as an international student, you’ll have to work within the constraints of a student visa (e.g., F-1 visa or M-1 visa) and take care to ensure that your activities don’t fall outside the scope of “volunteering.” Additionally, most American medical schools don’t accept international students, making it difficult for international students to land a shadowing role. We’ve put together a guide aimed at helping international students navigate the admissions process that even includes a list of medical schools that accept international students.
If you’re in the United States on a visa, you may (depending on the type of visa you have) be able to obtain work authorization that will allow you to shadow a physician, act as a medical scribe, conduct research, participate in a student organization, perform community service in some capacity, or engage in just about any other type of extracurricular activity that American students are doing. However, you must first qualify for a visa that would allow for work authorization. (Note: Some types of visas, such as the B-1 travel visa, don’t allow for such work authorization.)
Generally speaking, to qualify for a student visa, you need to be enrolled in an accredited school in the United States in your field of study. Therefore, unless you are in the United States on another type of visa, you need to be outside the U.S. when you apply for a student visa. This means that if you’re only in the United States on a B-1 visa for the summer, for instance, you would likely not be permitted to come to the U.S. just to shadow a physician. Instead, you would need a student visa and work authorization.
Volunteer work vs. unpaid internships
Sometimes students confuse “volunteering” with “unpaid internship,” but there is a difference and it’s an important distinction for international students. “Volunteer work” is when you donate your time to an organization that is typically a nonprofit or charitable organization. Internships, on the other hand, are generally related to your course of study. It’s not necessary to have work authorization if you’d like to volunteer for a nonprofit organization, but you need work authorization if you’d like to complete an unpaid internship within your field of study, such as scribing or shadowing a physician.
To help you determine whether the activity you’d like to engage in is an unpaid internship or unpaid employment, the Department of Labor provides seven guidelines known as the “primary beneficiary test.”
There should be no expectation for compensation. If there is any possibility that you’ll be compensated, the work would be considered “employment.”
The training needs to be similar to what the student would receive in an educational environment.
The internship should be tied to the student’s education program either through integrated coursework or academic credits received.
The internship should accommodate the student’s academic commitments and correspond to the academic calendar at the student’s institution.
The internship should be limited to a period of time where the internship provides beneficial learning for the student.
The internship should complement the work done by paid employees and provide significant educational benefits to the student.
The internship should not be directly tied to a paid role at the conclusion of the internship.
Part 6: Navigating extracurriculars as a non-traditional student
If you’re a non-traditional applicant—a student who is changing careers or is an older applicant—participating in extracurriculars presents some unique challenges. Adcoms won’t cut you any slack when it comes to the number of hours you should obtain in the categories listed earlier, and since most non-traditional students have an increased number of responsibilities than a typical premed, it can be difficult to get enough volunteering or shadowing hours while working around your busy schedule.
Balancing work, family, and academic commitments requires substantial forethought and planning, but it can be done. Here are some suggestions to get the most out of your extracurricular experiences as a non-traditional applicant.
Prioritize your commitments
Given the multiple responsibilities that non-traditional students juggle, it’s essential to prioritize extracurricular activities that align with your career goals and personal interests. As we mentioned earlier, you need to develop your filter and only focus on activities that are manageable and have a clear purpose for you.
For example, volunteering at a local clinic may resonate with you and their available hours may also fit within your schedule. As a non-trad applicant, you may have to “make this work” but as long as you’ve mapped out the best way to succeed, you’re more than halfway there. Remember, due to time constraints, it’s quality over quantity for non-traditional applicants even more so than standard premeds.
Seek flexible opportunities
Non-traditional applicants are inherently flexible because their busy lives demand it. You’ll also need to seek flexibility in the extracurricular opportunities you choose to pursue.
If you’re shadowing a doctor, what hours do they work? What hours will you be required to arrive and observe? Is there any leeway when it comes to emergencies? Keep in mind, that you’re also building an impression of yourself and your commitment to medicine. If you choose an opportunity without the flexibility you need, you could end up not getting enough hours or even being refused a letter of recommendation because you appeared unreliable to a doctor.
Some non-traditional students seek out opportunities at the weekend when they have more free time, or virtual extracurriculars in research or volunteering.
Leverage your unique experiences
As a non-traditional student, you bring diverse life experiences and perspectives that can enrich your extracurricular involvement. Use these experiences to your advantage by sharing insights during discussions or projects. Your background can provide a unique viewpoint that adds value to group dynamics and showcases your maturity and adaptability—qualities that are highly regarded in the medical field.
Your experiences can help you stand out, especially if you put them to work in a community service project, for example. Non-traditional students often have experiences that bring them to medicine or cause them to want to serve a particular population. Leveraging these experiences can give you ideas on how to showcase your leadership abilities while volunteering. A novel approach to a problem borne of experience is a great way to stand out on your application – and essays.
Build a support network
Navigating extracurricular requirements for medical school as a non-traditional applicant is tough and you would greatly benefit from having a support network to keep you motivated and on target.
Chances are, you’re not the only non-traditonal applicant in your area. If you meet others during a volunteering or research activity, be sure to establish a connection. Having someone else around who understands the challenges you face can be quite beneficial.
Additionally, online forums and support groups can provide encouragement and advice on balancing responsibilities. Through these avenues, you may even find professionals or med school students who have been where you are now who can offer guidance on your specific situation.
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Part 7: Med school extracurriculars Q&A with a former Harvard Med School adcom
In this interview, we spoke with a former admissions committee member at HMS, to get their perspective on how students should pursue extracurriculars for medical school.
How much weight do extracurriculars carry in a student's overall application?
Many applicants have great GPAs and it’s honestly hard to compare GPAs between institutions. And everyone selects students with strong letters. The applicant is differentiated most from others by the overall narrative of extracurriculars and the lessons learned from them. What does the student hope to accomplish in the future? What is their understanding of their personalized contribution and the impact they hope to bring to medicine? What extracurriculars have they done? Do they line up with and show evidence for the unique mission and goals the student discusses in their essays? Is there a longitudinal track record of a sustained and committed mission? Or are these extracurriculars totally unrelated to the applicant’s stated goals and vision and come across as a random collection of dedicated but directionless time spent?
As you can see, extracurriculars give life and body to the application. We care not just about the unique elements of the application but also whether someone sticks fast to their stated goals and has demonstrated a prior track record of exploration and success in those domains to serve as evidence for their potential impact in the future. If someone uses all the right buzzwords when discussing why they want to be a doctor (e.g., advocating for patients, scientific impact through research, working with underserved communities) but neither demonstrates a commitment to extracurriculars related to those fields (nor evidence of success/impact), then the application falls flat and blends into the 90% of other students who don’t get an interview. Ideally, the extracurriculars demonstrate a believable multi-year story of mission, passion, creativity, commitment, and impact.
We know leadership is important. What's the best way for a student to gain leadership experience?
This is tough! True leaders recognize that leadership is not something you just look around for. Often, the opportunity arises in a moment of need that is not immediately visible to all. I discuss this across the other answers, but ideally, students are leaders in things they are passionate about. It’s a semi-red flag when someone is a leader for an activity that they are only involved with for a short amount of time or when they appear to “shop around” for leadership in a sequence of short-lived experiences without impact. That impact piece is key. We don’t care about the titles. It’s hard to imagine a 70-year-old doctor caring much about the President or Vice-President titles of teenage college students in their pre-med club. We do care about the need they have filled, the lived experiences (as evident in essays and interviews), and the demonstrated impact.
While it can help to join organizations that have leadership opportunities in place, those can be competitive and degrade the meaning of leadership. Instead, students can demonstrate leadership in any activity they do by identifying an opportunity for change, impact, advocacy, etc., and stepping up to take extraordinary efforts to make that come to life. Even someone who contributes to their college community garden as a volunteer but decides to create large fundraising efforts to get better equipment so that more fresh produce can be used for the cafeterias is a clear demonstration of leadership in the absence of any title or position.
In our guide, we've told students to perform extracurricular activities in the following categories: community service or volunteer work, physician shadowing, patient exposure or clinical experience, leadership, and research. We also provide suggestions on how to spread their time (in hours and length) among those categories. Would you say that any of those categories holds more weight than the others? If so, which category, and why?
This may be a hot take, but I’d say that the least impactful areas are shadowing and clinical experience. Of course, it is a hard requirement that applicants need hours in this. But, due to the nature of volunteering and shadowing, there is less variation in what the students are actually doing and thus less contribution to the unique identity of the application. Students definitely need to spend time in these but after a point, doing an exceptionally large number of hours in these simple “participatory” endeavors doesn’t make an application stand out. I really don’t care if an applicant has 50 shadowing hours vs 100. We all recognize that shadowing is just standing around in passive observation and 50 hours is really enough of that.
The extracurriculars where the students have the opportunity to demonstrate different sides of themselves make the application unique. Through these, applicants can demonstrate a vision and mission, demonstrate resilience to adversity and commitment, exercise their creative energy to make a unique impact, etc. Thus, applicants can differentiate themselves the most from others through unique or dedicated approaches to their service, leadership, and research.
When it comes to research, we tell students not to necessarily expect manuscript publication credits as the culture of their particular research lab may not allow undergrad students authorship. But, many of the students we support have manuscript publication credits. In some cases, they even have first-author credits. How important is it for students to show manuscript publication credits on their application?
Firstly, not all students need research. Even at Harvard, we didn’t view research as a requirement. We just hope that students have demonstrated passion for something, and they demonstrate success with it. By default, many students choose to make that research. However, it is quite easy to tell when a student seems to have spent time doing research but does not demonstrate a true passion for it and does not seem like they actually want to pursue research in the future. If that’s what they are trying to base their application narrative on, then it’s actually disappointing and can be off-putting to read. Especially more if they are offered an interview, but can’t talk about research with passion or expertise. In these situations, we wish the students had actually spent more time on something they were passionate about.
Regardless, if the student does want to sell themselves as a researcher, then we need to see commitment and impact. If someone is doing research with a team (whether basic science or clinical research) for at least a year, I hope to at least see authorship on a conference abstract/poster, at the very least as a middle author. If their research team doesn’t acknowledge the student enough to put them as a middle author on a poster/abstract, that raises questions of how involved the student is and whether they are simply “participating” without “contributing.”
We would hope to see a first-authored conference poster/abstract or middle authorship on a published paper as more substantial evidence of making an impact through research. First authorship on a published paper is an impressive feat and certainly is not required nor expected.
One caveat: If an applicant is taking gap years and chooses to make research their main commitment during that, publication becomes an unwritten requirement. Every gap year a student takes, the standards go up. The reasoning behind this is that the student has clearly had more time to work on things, particularly if they appear to have done sustained research during undergraduate and then even longer into gap years. Not having any publications after 2-3+ years of research raises a lot of questions about productivity and contribution to the team.
We suggest students spend "more time on fewer things," but some of our students tell us that they worry this will look bad simply because they don't have very many activities. What is your take on this?
I mention this in my other responses. There are some bare minimum essentials (e.g., shadowing, volunteering) but I hope to see depth rather than aimless breadth. Anyone can spend time doing a lot of entry-level tasks in different activities. It’s much harder to actually make an impact and tell a meaningful story.
In our guides, we tell students that becoming a "superstar student" should be a goal and that it's okay if they choose a "specialty" outside of medicine (e.g., service). Some of our students are skeptical about this, though. What is your take, as a former adcom? Can you share why this is okay to do, from your point of view? How do you evaluate students who seem to be rock stars in an area outside of medicine?
It takes a balanced approach. As I mentioned earlier, we want applicants to demonstrate a sustained mission and impressive impact in what they do. And that can take many forms. Not everyone is passionate about the cookie-cutter premed path (but unfortunately too many think that is the only way). But at the end of the day, it has to relate and be applicable to medical school through clear and evident efforts to relate the fields whether by the relevance of the endeavors themselves or by fundamental values. A few examples (loosely adapted from real examples!):
Applicant 1: A nationally recognized musician who did a post-bacc with great grades and is applying to medical school. Has some volunteering and shadowing. Was a member of the internationally renowned Chicago Symphony Orchestra and ranked in an international competition. Performs solo recitals around the country. But no other extracurriculars related to medicine. This is clearly a talented applicant with an extremely unique skill set and great grades, but why are they applying to medical school? They have not shown evidence of exploring the field beyond the bare minimum. No mention of pro-bono or charity efforts using their unique musical talents?
Applicant 2: Started freshman year unclear about what to study and spent time becoming a fashion influencer on TikTok for fun. Friend struggles with mental health and suicidal thoughts. Student starts using her platform to talk about mental health challenges in her college community and is surprised by the immense supportive response on TikTok and responses from other students who felt empowered to come forward with their stories. Student takes coursework on social media, digital marketing, and mental health and starts taking pre-medical courses. Partners with national organizations advocating for mental health and helps to design and create content for them. Now she wants to become a psychiatrist and get a Masters in Public Health to advocate for mental health and think about how medical professionals connect with younger generations. Clearly an organic story and mission with a demonstration of sustained impact and a desire to connect it to medicine and patients.
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Part 8: Frequently asked questions about extracurriculars for medical school
Is research the most important extracurricular for top MD programs?
As we noted above, the importance of research will vary from program to program. Generally speaking, research can play a critical role in your acceptance into top MD programs because it demonstrates your desire to pursue academic medicine and advance science.
That said, research alone isn’t going to get you accepted into a top medical school, nor does it need to be your top extracurricular activity in terms of hours spent or achievement. According to an AAMC survey of adcoms from 130 schools, research plays a “medium level” role in the overall application process. This means that it’s viewed as important provided you have other notable accomplishments–namely, leadership and clinical experience–but it’s not the most important.
Is it true that some schools value clinical or service experiences more than research?
Some students mistakenly believe that certain medical schools are “research schools” vs. “clinical or service schools.” The question, “Which is more important?” ignores the fact that medical schools want to see you pursue all areas and that no area of extracurricular activity will, on its own, make your application stand out. Put differently, research, clinical, and service experiences add something different to your application.
Having said that, it’s important to demonstrate outstanding achievement in one or more extracurricular areas and to tie your achievements to specific programs or initiatives at each school to demonstrate fit. A classic example is to link your experience working with communities that are underserved to a medical school’s primary care initiatives.
How much clinical experience do I need if I intend to apply to MD/PhD programs?
Another misconception is that med schools expect little, if any, clinical experience from students applying to MD/PhD programs. However, it’s important to remember that medical schools primarily aim to train clinical physicians and keep patient care at the forefront.
To remain competitive for admissions, you should have at least 200 hours of clinical experience—we recommend 500+ hours—regardless of the program you intend to apply to. With MD/PhD programs, however, it’s typical for research to be the primary or most impressive extracurricular experience.
How do adcoms view extracurriculars that I completed during high school?
From an application standpoint, extracurricular activities you completed during high school generally aren’t considered by adcoms, unless you continued them during undergrad or beyond.
You’ll note the start and end date of each activitiy in the Work and Activities sectionof your AMCAS application. If you began an experience in high school that you continued while in college, it’s okay to mention that on your application and count the total hours you devoted to it.
Does being a TA look good for medical school?
Serving as a teaching assistant (TA) is wise if you’re looking to build an extracurricular profile that highlights your interest in teaching, mentoring, or academia. In addition, your TA position could yield an excellent letter of recommendation when applying to medical school.
If you decide to pursue a TA role, we advise you work with a professor whose course you received an A grade in, or whose lab you work in as a research assistant (RA). In doing so, your letter of recommendation will be strengthened because the professor will have observed you in multiple contexts.
Can I get into med school without extracurriculars?
No, it is highly unlikely to get into medical school without any extracurricular activities. We sometimes hear of students who want to know if they can get into med school on grades and test scores alone, but the fact is medical schools place a strong emphasis on extracurricular involvement when it comes to the admissions process. Even students who’ve been accepted to early assurance or BS/MD programs still need a healthy amount of extracurriculars to ensure their spot is secure.
Final thoughts
We often only hear about the outcomes of persistent hard work, such as the nonprofit organization, the major publication, or the new health care curriculum.
When faced with the decision to make something similar happen, we can feel intimidated by the mountain of work required to make it happen. However, mountains are climbed through a long series of small steps.
Being a premed superstar is no different.
About the Author
Dr. Shirag Shemmassian is the Founder of Shemmassian Academic Consulting and one of the world's foremost experts on medical school admissions. For nearly 20 years, he and his team have helped thousands of students get into medical school using his exclusive approach.
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