M1 at Washington University in St. Louis

frances avila-soto

Latina

Traditional Student

First in family To Attend Medical School

TL;DR

Puerto Rican - born in PR and moved to the states as toddler
Lived in rural, Midwestern area with little diversity and lack of resources
Went to large state school for undergrad; competitive, research-based major (Biomedical Science)
“Traditional” student - applied straight out of undergrad

Update: Jan 2021

The first few months of medical school have certainly been a whirlwind. Anyone currently in school knows that taking classes during a pandemic has been challenging to say the least. It’s difficult to bond with and get to know your classmates when you can’t all be together at once, and that makes it harder to build a support network. On top of that, the Zoom fatigue is real when you’re watching back-to-back online lectures at your desk for 8 hours a day. And that’s all in addition to the incredibly demanding course load that is characteristic of any medical school (if you haven’t heard the “drinking out of a firehose” analogy, consider yourself lucky). While I expected medical school to be challenging, it was definitely still a bit of a shock. I learned to let go of my perfectionism in undergrad, but even so I still had to remind myself after our first couple exams that in a Pass/Fail curriculum, it actually is okay to “just” pass.

Despite the difficulties, medical school has brought some very positive changes with it as well. Even with COVID restrictions, I’ve managed to get to know a decent portion of my amazing classmates through outdoor activities and six-feet-apart study sessions in the library. Ironically, I’ve also learned to relax a bit. A P/F curriculum means I can focus more on understanding content than achieving a certain grade, and I don’t have to stay up all night to memorize minute details. I mentioned in my original case study that I got a little too involved in extracurriculars in undergrad. Though it’s hard to break old habits, I’ve been trying to be cognizant of my limits. In doing so, I’ve managed to balance my time and commit only to things I truly want to be doing instead of trying to pad my resume. I’m purposefully using my pre-clinical time in medical school to figure out what I want to do specialty and career-wise (very undecided in that realm, but thankfully so are many of my classmates). Additionally, I’ve also been using this time to focus on myself and let go of comparisons. As I wrote in the imposter syndrome one-pager, it’s easy to compare yourself to others and start wondering whether you deserve what you’ve achieved. Medical school is a place full of incredibly smart, driven people. Admittedly, I was intimidated by some of my classmates and their achievements when I got here. But the reality is that I’m here for the same reasons they are: to learn and become a great doctor, and my classmates and I are here to support rather than impede each other in that process.

Background

If you asked seven-year-old me, she would have told you that she wanted to be a veterinarian (while moonlighting as a rock star, of course). Somewhere along the way - I think around middle school - my interest in healing cute, fluffy animals transformed to an interest in treating humans. Though there are several reasons for this, I’d be lying if I said my identity as a Puerto Rican didn’t play a large role. My older relatives grew up on an island where healthcare was, and still is, a luxury for some. Large hospitals are few and far between, and specialists are scarce. I grew up hearing all-too-frequent news of family members who had passed away due to things like diabetes-related complications and heart disease. At the time, I accepted this news as the harsh reality. I didn’t realize that many of the complications my older relatives experienced could have been largely preventable with proper access to healthcare and health education. Before my senior year of college, I started volunteering at a Spanish-speaking clinic in the Midwest, and I came to understand that this lack of access for Latinx populations is not isolated to one area. Many patients I have encountered in the clinic have experienced language and cultural barriers when they have tried to seek access to healthcare elsewhere.

As a Latina, I want to advocate for patients like myself and my family who have been historically underprivileged and marginalized so that they don’t succumb to the same fate as my relatives.

Early Years

For the first few years of my life, my older brothers, parents, and I lived in a small Puerto Rican town near all of our grandparents, aunts, and uncles. At the time, my mom worked at a local university as an engineering professor for undergraduate students. She liked her job but knew she wouldn’t be able to ascend without a PhD. There weren’t any PhD programs in her field in Puerto Rico at the time. After a recruiter came to her university, she and my dad made the tough decision to leave Puerto Rico and our extended family to obtain higher education at a US institution.

My family experienced economic hardships for the first few years after leaving Puerto Rico. With my parents going into debt for their graduate education, money around the house could be tight. We received assistance through the Food Stamps Program and Medicaid. Our first few years in the states were a period of adjustment, but my parents’ investment in their education paid off. Eventually, we moved to Ohio where my parents were both able to find good jobs in their respective fields, and we were far better off financially. That kind of upward mobility is not always attainable in the US, and looking back on my own family’s previous struggles makes me incredibly aware of the privilege it is to now be financially sound - especially when applying to medical school.

Though we were better off financially, moving came with other struggles. To say the least, rural Ohio was not always the most welcoming to a Puerto Rican family. There was an incredible lack of diversity at my school with 97% of the student population being white. I faced racial/ethnic slurs and derogatory comments on a fairly regular basis. Additionally, being in a rural school meant a lack of resources. At the time, I considered my high school to be decent in terms of academics, but when I went to college I realized that other students had had far more opportunities than I had. Several people I had talked to had conducted research in high school and took AP classes their entire junior and senior years. My school offered a total of 6 AP classes, and research was a concept from another universe. Getting students to graduate was considered an achievement. Despite this, I was accepted into a competitive major at my university with a full-ride scholarship.

My Pre-Med Journey

Entering college was an incredibly exciting but sometimes overwhelming experience. As I previously stated, my major had a competitive application process. My fellow admitted students had all come from the top of their classes, and their academic backgrounds both impressed and intimidated me. At times I felt inadequate, but I pushed forward reminding myself that no matter our backgrounds, we were all now in the same position. Since our major had a two year research requirement, I joined a research lab towards the end of my freshman year. To be honest, my experiences with research were a mixed bag. I thought that the focus of my lab’s research was interesting (elucidating the link between HIV and cardiovascular disease), but there were certainly times where I felt I was way in over my head. The postdoc in my lab was incredibly supportive and helped me conduct my experiments. However, I always felt that I struggled a bit compared to the other undergraduate in the lab. I fumbled over “simple” procedures at times and stressed over the minutiae of my experiments to the point that my experiments took much longer than they should have. I came to the conclusion that wet lab research wasn’t something I greatly enjoyed or was passionate about. I decided to stay in the lab until senior year because I appreciated the supportive environment, and my last year I focused more on data analysis for other lab members rather than conducting my own experiments. That arrangement seemed to work better for everyone in the lab, and I learned an important lesson in being willing to admit my weaknesses.

By acknowledging that I struggled with bench work I was able to find my other strengths which ultimately benefited the lab as a whole.

Going into my sophomore year, I decided to get involved in organizations outside of academics and research. Due to the lack of diversity in my high school, I naturally gravitated towards the Latinx community at my university. I joined several Latinx-oriented organizations and felt that I had found “my people.” I even ended up on the executive boards for a couple of these organizations my sophomore through senior years. Looking back, I feel that my non-academic involvements had more of an impact on me than my academic ones. I grew both as a leader and an advocate for my community and found an incredible support system. That being said, I recognize that at times I got too involved. I got so immersed in these organizations that sometimes I put my own academics on the backburner in order to organize events and community projects. While I don’t regret being involved, I recognize that I should have focused more on time management and prioritization. There were times where my mental health took a toll because I was trying to do everything - be a leader, organize events, ace my exams, etc.

One of my advisors had to remind me, “Remember why you’re here. You’re a student first.

Though it was difficult because I was passionate about my involvements, I knew I had to refocus. If my career goal is to advocate for my community/other underserved communities as a Latina physician, I have to work on becoming a physician first. My junior & senior year I learned to delegate more tasks to my fellow executive board members so that I could prioritize my application cycle and interviews.

Though my major and academic advisor prepared me well for the application cycle, I was still met with certain surprises. First, I didn’t expect the staggering cost associated with applying to medical school. I applied to 21 MD schools, and between primaries and secondaries I spent around $3,000 (and that’s not including travel costs once interviews rolled around). I felt very lucky to have extra scholarship money and parents who were willing and able to support me how they could throughout the cycle. For those students who do not have similar opportunities, I highly recommend looking into the Fee Assistance Program and possible scholarships/grants offered by your university or outside sources. Secondly, I was unprepared for the struggles of balancing interviews with my academics as someone applying in undergrad. There were times where I rushed out of an exam in order to catch a flight to an interview or had to work with my professors to reschedule exams. Though it was manageable, applying as a student requires a lot of time management and planning ahead to ensure you can continue to succeed in your coursework.

And Now...

By the end of the application cycle, I was accepted to 7 MD schools (10 interviews; 6 acceptances, 1 waitlist turned acceptance, 1 WL that I withdrew, 2 post-interview rejections). I felt honored to have received acceptances to so many great schools, but I’d be lying if I said it wasn’t overwhelming at the same time. Imposter syndrome started to kick in, and I wondered whether I truly deserved all those acceptances. Online forums debating whether URM students had it “easier” in the application cycle certainly didn’t help. Neither did one interviewer’s implication that my application was impressive for a URM student. The truth is, I have no way of knowing what impact my identity may have ultimately had on my admissions decisions.

What I do know is that I worked hard to get to where I am and that my application demonstrated my dedication and passion.

I also know that diversity is incredibly valuable in medicine, and it is important for patients to see physicians that represent their own communities. So, as I move forward into a career in medicine, I know that despite my own (or others’) doubts I have the ability to become the physician that my own family members deserved years ago.