Pre-Med Culture: A Toxic Chokehold

Hello everyone and happy Tuesday! I am sure you are all excited to get on with Thanksgiving break. However, we have one more post to leave with you to ponder. I had the wonderful opportunity to speak with Julia Smolen, a current MS1 at Virginia Commonwealth University Medical School. Julia is a Maryland Alumna who recently graduated in Spring 2020 with Bachelor of Science in Neuroscience and Biochemistry. Originally on the biochemical path to research, Julia realized in undergrad that something was missing in her journey: a connection with patients and people. Thus she switched into the pre-med track and entered the realm of pre-med culture. In our discussion, we delve into the topic of what many of us know as “toxic” pre-med culture and its impact on us as students and future health care professionals.

Defining Pre-Med Culture:

julia smolen photoAre you ever overcome by the feeling that you are not doing enough even though you are the leader of 2 clubs, working 3 jobs, and constantly volunteering? Ever look around and think, “I’m not where they are”? That, according to Julia, friends, is comparison. It’s one of the hallmarks of pre-med culture and the greatest  thief of joy. In our discussion, Julia asserts that competition is at the very center of pre-med life and although it did not deter her path to medicine, it still did the damage; creating some form of mental block that continuously makes her anxious and feel, as she describes, “less than”. If this is your story, then you are not alone. Competition, as it relates to pre-med culture, does not necessarily stem from one person, instead it is innately present in the system that pre-meds are seeking to enter into. It is the interpretation that ambition should be at the forefront of their mind which fuels the harmful culture that is the pre-med environment.  Current pre-med culture insists that students must always get the highest score on every exam, and often this may come at the expense of their sanity. According to Julia, seldom are there people who explicitly tell you that you are not where you need to be, instead it is an internal battle. 

“We are all battling ourselves without even realizing it. ~Julia

Gatekeeping and Competition:

Gatekeeping and Competition are two components of the toxicity of pre-med culture. Self-reflection time: think back to a time in your pre-med journey where you realized that you had a  very helpful, top tier resource. Did you share it or keep it to yourself? Have you ever had an opportunity that you happened to stumble upon, and found yourself being vague when your friend asks about the it? Have you ever felt resistance when asking someone for a resource that helped them in the past? You may be wondering whether or not you were gatekeeping. Julia also engages in some self reflection and sighs as she recalls her time in undergrad as a time when people were unwilling to share resources or opportunities. She concluded through her experiences that many pre-med students are more willing to share general programs rather than specific resources that may be beneficial to another student, whether that be notes from a class or resources for MCAT. 

Gatekeeping is not always intentional. Julia mentions that gatekeeping can be situational based on the connections people have. It is inevitable that someone will have a network of individuals that can assist them to higher places. However, some students may unconsciously see their peers and friends as threats to their network and deceive them when asked about how they gained their opportunities. 

Does Pre-Med Culture Disappear in Medical School?

In her experience at VCU Medical, Julia compares the medical school culture to the pre-med culture in undergrad, “It changes, but I would not say that it gets better”. According to Julia, people are more willing to share resources and guides because it is left up to the medical student how they use the materials. However, competition and comparison do not stop once you enter medical school, because residency is just as pressing and competitive. The toxic cycle of feeling inferior or unaccomplished compared to peers perpetuates and manifests itself in various ways. Dr. Shawnese and Brian Clark discussed some of the manifestations of inferiority, self doubt and imposter syndrome in their “You Belong in Medicine” talk last week. They ultimately came to a similar conclusion, the pre-med lifestyle is further seen in medical training, however it is important to stand strong and never let that deter you from the path. Stay tuned in the Spring for the next installment of the HPAO and Drs. Clark collaborative discussion on confidence and imposter syndrome in medicine. 

So What?

Now that we’ve discussed the ways toxic pre-med culture manifests, you may be wondering what are the consequences of such a toxic culture?  The perceived pressure to go above and beyond peers can often drive pre-med students to ruin relationships with their friends, neglect their mental health, and ultimately have a certain dissociation from life. As doctors, we can not expect to help others if we are intentionally downplaying each other to elevate ourselves. It is easy to become overwhelmed by thoughts of inadequacy and failure, however, it is important to realize that you are not alone in this journey. By perpetuating the toxic pre-med narrative, many of us will be left feeling alone and withdrawn. During our discussion, Julia says she regrets not partake in some of the fun opportunities afforded to her because she was not living in the present. 

“Even taking those few minutes, maybe even an hour is enough to keep you grounded and present.”

Though the pre-med lifestyle requires motivation and sacrifice, it should not dictate and prevent one from being present and enjoying each stage of the journey. Julia emphasized the importance of realizing when you need to take a break from the workload of pre-med life and see the beauty of each experience you are afforded in the season you are in. 

As the years go by, discussions surrounding the pressures of pre-med culture have been more prominent. Julia encourages us to think about how we can help change this culture and help create a more supportive and welcoming environment for future pre-med students. I hope you enjoyed today’s post and have a wonderful Thanksgiving.

With Care,



“The pre-med journey is stressful and does not end in undergrad, so it is important to do things that you enjoy. This will allow you to have a story, one that is unique to you and offers a different perspective. ~Julia

Editor: Lisa Anoruo