Deep dive into Duke Medical with Dr. Linton Yee

Early patient exposure and the option to pursue research or an additional degree during the program’s third year, make Duke University Medical School a unique choice for applicants. Dr. Linton Yee, Associate Dean for Admissions at Duke University School of Medicine discusses the program’s integrative learning approach that offers students hands-on training from day one in Accepted's podcast series, Admissions Straight Talk.

Interview with Linton Yee, MD

Our guest today is Dr. Linton Yee, Associate Dean for Admissions at Duke University School of Medicine. Dr. Yee earned his bachelor’s and MD at the University of Hawaii. He then did his residency in Pediatrics at Harbor-UCLA Medical Center and a fellowship in Pediatric Emergency Medicine at Children’s Hospital in Los Angeles. From 1996 to 2007. He practiced and taught Pediatric Emergency Medicine in Hawaii and California, before taking a position at Duke University as an Associate Professor in the Department of Pediatrics’ Division of Emergency Medicine, and a pediatric emergency room physician. He’s also Duke Medical’s Associate Dean for Admissions, and it’s in that capacity that I have invited him back to Admissions Straight Talk for a show devoted to Duke Medical.

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Dr. Yee, can you give an overview of Duke Medical’s highly distinctive curriculum? [2:11]

We’ve had this curriculum in place for a number of years, and the goal is to produce leaders in medicine and also to help the applicant and the student, eventually, understand the link between clinical medicine and research, and how both of these things help to promote, advance, and improve medical practice. Our curriculum is changing right now, and we’re putting in new elements in what we call ”patient first.” I think all the applicants and med students out there have to understand that the patient is the center of your universe and everything you do has to be done to improve their well-being. So we’re shifting a lot of our thinking now, and actually using the immersion of the med students into the first year, from day one so you’re seeing patients from day one. We’re then integrating a lot of the biomedical concepts with that. So you’ll have early clinical exposure, and you’ll have a lot of the foundations within that first year. That first year is still your basic science year, but with a lot of clinical elements integrated in.

The second year is still your clinical year and then the third year is where we actually have you do research or get an advanced degree. That’s where you get a chance to choose your own direction and get to pursue your passions. If you think about it, there are very limited opportunities for you to do that within med schools in the United States. So this is really a chance to do what you want to do and to utilize everything that you’ve done in the past to pursue what you’re passionate about and that’s kind of how things are set up over here.

If you’re having all of your early clinical exposure and also doing the entire didactic portion in your first year (which many medical schools take two years to do) how do you fit it all in? [4:02]

We try to integrate everything well and I think you’re able to process all of that information if you can link everything together. If you can link concepts like for example, “What’s cardiac output? Heart rate times stroke volume.” But then you see someone has tachycardia, their stroke volume is diminished so how do you adjust this and how do you compensate for all these sorts of things in terms of using a basic formula like that? So I think by integrating all these elements early on, you can see how everything works together. Back when I was in med school, that was part of the frustration. You would just sit there in class and read about things, but you would never actually see it. Here, you get a chance to actually see things actually working together and then you have a chance to learn that better and you process it better. So it becomes, in essence, much easier for you to retain that sort of information and integrate it to other concepts.

 

How has Duke Medical adapted the med school experience in light of COVID restrictions? And what do you think is going to stick around and become permanent as a result of those adaptations? [5:39]

COVID led to some significant changes. All the students had to be pulled off their clinical rotations. The way they did it last year is they made all the didactic parts happen when all the students were still limited in their ability to go in the clinical routes and then they were able to come back into the clinical realm after things got a little bit better. That’s how that happened but I think now we’re still trying to go back to the way things were. Everyone has to mask up, the students can’t see the COVID positive patients right now. Unfortunately with COVID, almost everybody’s testing positive now, as opposed to when everyone was testing negative a handful of months ago. So this is almost reminiscent right now of what it was in the late summer, early fall, at least for us. 

Your secondary application is one of the more thorough and demanding applications. What are you trying to glean from this very comprehensive secondary? [7:15]

There’s a number of different elements behind this. I mean, the simplest one is that it’s a self-screen. If you’re willing to put the time into this, if you’re interested in Duke that much you’ll fill out the essay. But I think, probably, the more important part is all our applicants really have to reflect and understand why they’re going into medicine. The way the questions are structured, it’s to really get you to examine your reasons for this, because this is going to be the greatest undertaking you’ve ever done. You have to be prepared for this and, hopefully, truly understand why you’re embarking on this lifelong journey of service to others and committing yourself to doing your job in the highest fashion possible.

It’s primarily to get the students to understand, because we feel that if the student understands why they’re going into medicine, it makes them a better applicant. It’s not necessarily just for us, per se, at Duke, it’s for them to be a better applicant at every school. You’ve got to know what you’re getting into and why. You have to be going into this for the right reasons, and your vision has to be clear, in terms of how you see yourself working for others in the future.

[Duke University School of Medicine Secondary Application Essay Tips (2021 – 2022) >>]

You mentioned earlier that Duke is having a very healthy increase in completed secondary applications, can you tell us more? [10:35]

We did our first podcast three years ago (at roughly the same point in the application cycle) and at the time, there were 4,330 applications from AMCAS. Right now, there are 6,267 applications. But the even more important part here is at that time, we had 1,100 completed Duke secondaries. Now, we’re at 2,155 and this is only 20 days into our cycle.

That’s amazing. Given that, it looks like it’s going to be a pretty intensely competitive year at Duke. What process does an application go through when it’s marked completed? When you have a completed secondary, what happens to it? Does it go into a black hole? [11:34]

It’s a holistic review, we look through everything. So there’s no cutoffs and we’re going to go through the entire application. What we primarily do though is we focus on the essays and the experiences. That’s going to be the key determinant there. Again, you’ve got to put something valuable into the essays and you have to have relevant experiences – clinical research, community involvement, investment in others are the key components of your application that we’re going to be looking for.

When an application is reviewed, is it reviewed by three people? Do you discuss the applications as a committee? What’s the process? [12:39]

So initially it’s reviewed by one person and then after that, it’s reviewed at another level, and then after that, another level. There are a number of people who are going to go through every one of those applications.

So even an application that, let’s say, the first person looks at and says, “No way this person is getting in,” even that application is going to get reviewed by somebody else? [13:01]

That’s correct. Yes. The way we have our website structured for the applications, you have to click on it to say that you’ve reviewed it so we know when it’s been done.

And let’s say it’s reviewed by three people, how many have to say they want to interview the candidate for them to be invited for an interview? [13:24]

Everyone would have to be in agreement to interview.

What can someone invited to interview at Duke Medical expect from the interview day/week, given that everything is virtual? [13:43]

Last year was virtual, and fortunately, our team here is fantastic. It took like six months of preparation to get it down, but we actually were able to get everything so it worked in an efficient manner. So the way it’s structured is we can only do 10 people a day, just because we had to rotate people through rooms. I think now we’re probably going to be able to do 11 people per day. 

Then on that Sunday evening of the interview week, we always have all the people interviewing for that week get together and you’re grouped within your interview day so you have the opportunity to meet the other people that you’re interviewing with. Then during that Sunday evening, our students pretty much run that evening so they’ll discuss what it’s like to live in Durham, what the Duke curriculum has to offer, and answer any questions that the applicants have. Also, we used to have the research and leadership elements into the actual interview day, but we found that that was kind of distracting the applicants from the actual interview process. So we shifted them over to that Sunday, so now when the interviewees come for their actual interview, you’re only there for your MMI stations. The Sunday’s got everything together and we try and keep it down to like just a couple hours, so it’s not lasting the entire evening.

Then when they’re actually here for the interview, they need to check in around 12:30ish just to make sure the connections are good and everything, and then hopefully we’ll have them out of here roughly around 3:15ish or so.

How do the virtual MMIs work? [15:41]

We have five stations in which there’s a scenario. It’s fairly similar to what we had been doing before, when we were in-person, and then we have the team station, which we had to change since we can’t use what we had used before. Now it’s more things that are two dimensional — without giving up out much more information — it’s things that both of the applicants can do via Zoom. Again, our team here was really creative in figuring out how to do that. Then we still have the two traditional interview stations (one-on-one), which we had had in the past. And then a new station in which the applicants would need to observe the interaction of two medical students and assess what’s going on and then offer a solution and observations as to how they might remedy that situation.

 

We hope that at some point in time COVID will be in the rear view mirror and travel restrictions will ease. At that point in time, do you see Duke Medical returning to in-person interviews or some in-person, some virtual? What do you see happening? [16:59]

That’s an excellent question, and I think a lot of schools are facing that as well. On the plus side for the applicants, interviewing virtually has no cost – the impact on your finances is limited, you don’t have to worry about airports and weather, you don’t have to worry about getting to the airport with traffic, you don’t have to pay to stay overnight at a hotel or those sort of things. But on the flip side, I think a lot of schools miss the interaction with the applicants and being able to have students talk with the applicants and get a chance to show what the facilities look like and actually talk to the applicants about what it’s like to live in your city.

There’s two different pluses and minuses there, but I don’t think we can go to a hybrid model because it would be hard to differentiate whether there is an advantage or disadvantage to doing it in-person versus virtual. Are students being evaluated within the same manner if they’re doing it virtually versus in-person? It would need to be one or the other and I think most schools would probably end up going back to in-person. This year almost everybody opted to go virtually, just to make things consistent.

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