The medical school application process is infamously one of the most confusing processes any hopeful pre-med will have to tackle before getting into medical school. As a first-generation applicant, I was honestly surprised by the amount of “jump scares” that I encountered while applying. While I am fortunate to have done my undergrad at a university with many pre-med mentorship opportunities, I still had so many “man, I wish somebody told me this” moments than I would have liked. So, here’s my list of things that nobody tells you about medical school applications so that you hopefully won’t face the same distress when you’re applying.

1. The application cycle is SO expensive.

The cost to apply to medical school can be overwhelming. I knew medical school was expensive, but the application itself is its own monster. There are so many hidden costs to prepare for. Here’s a rough list of the costs you can anticipate when applying:

• MCAT ($345): The standard registration fee for the MCAT is $345. Mind you, this does not include the cost of taking it multiple times, any rescheduling fees, preparation for the exam, or if you are an international student, the additional international fee.
• MCAT Prep Materials ($400+): So you signed up for the MCAT. Now you have to study for it. There are very few people I know who have successfully completed the MCAT without dropping money on prep materials. Most people will buy a UWorld subscription (and if you’re like me, continue to extend it) plus an AAMC Prep and Exams Bundle. Those two resources alone will bring you to at least $400.
• Other Exams ($185+): Depending on which schools you’re applying to, you’ll need to take the CASPER ($85 for the first seven schools) and/or AAMC PREview ($100).
• Primary Application ($175 + $47/school): The “primary application” is the initial application sent to all schools you apply to through AMCAS. This application includes your demographics, work and activities, and personal statement. The cost of applying for the 2024-2025 application cycle was $175 for the first school plus $47 for every additional school. You can imagine how fast that builds up when you’re trying to “cast a wide net” to schools across the nation.
• Secondary Application ($50-125/school): After submitting your primary applications, you’ll likely receive “secondary applications,” or a request for supplementary essays from multiple schools. Some of these schools will send secondaries to everyone, while others will selectively screen applicants. Every secondary has a fee associated with it. During my application process, the lowest fee I had was $50 and the highest was a whopping $125.
• If applicable, travel for interviews: While all my interviews were conducted via Zoom, I did have some friends who traveled for in-person evaluations. This is an additional cost to take into account post-submitting your application.

2. The MCAT is not the only exam you have to take.

After finishing my MCAT at the beginning of my senior year of undergrad, I was relieved that I did not have to take any other evaluations to apply. Unfortunately (and this is one of many unfortunateities encountered), I was wrong. To create a “competitive” list of schools, you will probably need to take at least two other situational judgement tests: CASPER and AAMC PREview. Both these exams are deemed “money grabs” (rightfully so), but they’re necessary to apply to several schools in the system. As far as I have heard, most schools will use either exam as a supplementary component of your application rather than as a determinor. This is likely due to their newness. In fact, some schools only require you to submit scores for research-purposes.

• CASPERE: CASPER is an open-response situational judgement exam administered by Acuity. Most questions are along the lines of “tell me about an experience…” or “here’s a conflict, what would you do?” You’ll learn from repetitive practice that most scenarios have a basic logical framework you can follow.
• AAMC PREview: I honestly had never heard of AAMC PREview until the April before applying. AAMC PREview is a multiple-choice test that will present you with a conflict or scenario and several different ways to address the situation. You’re job is to rank how effective a solution is at addressing a situation (it makes more sense when you look at the practice test). Honestly, PREview was more difficult than I anticipated. It felt like I needed to address each situation with a logic I would not naturally use in order to match the correct answers.

3. Prepare for your Letters of Recommendation early.

One of the greatest stresses I had while applying was making sure I had enough letters of recommendation (LORs) and that they were all in on time. While I knew that forming connections with my professors at a large public university was going to be challenging, I definitely was not anticipating the amount of effort that I needed to put in. I had no idea what kinds of letters I needed, let alone how to go about requesting them.

We can briefly break it down into five steps:

• Forming a relationship with your writer: This can look like anything from getting to know them in an extracurricular to visiting their office hours to stand out in a class of hundreds. This step is easier if you’re in smaller classes or a private program. I chose to wait until I was in my upper division classes to start this process since our class sizes are less than half of any of the pre-med prereq classes.
  • To apply to med school, you’re going to need at least four letters: 2 from science and/or math professors, 1 from a humanities professor, and 1 from a research PI or extracurricular leader. Ideally, you would have all five types.
• Asking your writer: I found it most convenient to ask a month after the term had ended and I was sure I did well in the class. Rule of thumb is do not ask any professor in a class that you did not get an A in. Most of my requests were over email, thanking the professor for an excellent class, touching on some things that I enjoyed, and even talking about a skill I got to improve during their course. I made sure to specify that my deadline was May of my application cycle, giving them ample time.
  • Make sure to ask early. Some professors have a limit to how many letters they are willing to write in a given cycle and can turn you away!
• Completing any supplementary materials for your LOR: Almost all my professors asked for a CV, a rough draft of my personal statement, and/or responses to their own LOR question packet in order for them to write strong LORs. As tedious as it may seem to answer their questions, remember that these reflections are often indiciation that your professor is doing more than just writing a generic letter.
• Reminding your writers to submit on time: Because I asked in advance, I made sure to send reminder emails to my writers at the one-month mark and again at the one-week mark to make sure they submitted on time.
• Submit your letters: I used Interfolio to store and send my letters. I am not sure of how others send their letters to AAMC, but I would ask any mentors that have completed the cycle at your univeresity or even professors who are experienced at writing and sending LORs.

4. Different programs have different course requirements.

I did not realize until midway through the application cycle that there were several programs I had applied to and did not meet the requirements for. I graduated college with the assumption that I had checked all the boxes for courses required for medical school, especially since my major was pre-med heavy and in the life sciences. It was not until receiving secondary applications for several programs that I realized that I did not meet the pre-requisites, and that I had wasted money on sending a primary to that program in the first place. For example, I could not apply to Miami Miller because of their behavioral sciences requirement. While most schools recommend psychology/anthropology/sociology, Miami Miller requires a year’s worth of courses in this category.

After doing a deeper dive into the niche requirements for different medical school programs, I realize that this is a trap that many applicants without guidance fall into. Many schools do not openly reveal their course expectations on their website. I recommend reaching out to friends or mentors who have previously applied for more insight. While most undergrad programs will provide basic course recommendations for pre-med students that will comply with most pre-requisites, I recommend researching any program you specifically are interested in.

5. You’re expected to go “above and beyond” to show interest.

At this point, it is clear that nothing about applying to medical school is straightforward. To add to an already lengthy list of expectations when applying, several medical schools will expect engagement beyond the traditional application and interview. In fact, some might even go as far as to tell you that your application strength is impacted by your engagement with the admissions office.

When you’re applying, there are three key times you will engage with admissions: submitting your primary application, submitting your secondary application, and if you interview for the program. Outside of these times, there are several unspoken/less emphasized engagements you’re expected to have to truly have a leg up in the admissions game:

• Update Letter: This is the better known of engagements and one that most schools will expect from you post-interview. In an update letter, you’re expected to provide any significant updates since submitting your application as well as a small blurb tying your updates back to the program’s fit for your goals.
• Letter of Interest: A letter of interest is one that you send to the top three schools on your list post-interview. These letters are usually clearly marked as interest and have phrasing that emphasizes this school is at the top of your list (but not number 1!). The risk in sending a letter of interest is that while it could be interpreted favorably amongst some admissions committees, to others, it might be viewed as a red flag that they are not your number one choice, especially in a situation where they are trying to quickly fill their class.
• Letter of Intent: This is a level up from a letter of interest. A letter of intent should be sent to one school that is your top choice. This letter specifically is intended for a program that you will undoubtably attend if accepted. While it is technically non-binding, I have heard that writing a letter of intent and later failing to follow through with it could result in consequences when applying to residency or engaging with that program in another form. A few of the programs I interviewed for let us know that they take letters of intent very seriously when it comes to admissions decisions.
• Other engagements: This category definitely surprised me the most. Some admissions committees will keep track of how often you reached out to different programs, professors, or even your interviewers post-interview to learn more about the program. The few schools that expected this kind of communication did mention it during their interview days, but it was stressful brainstorming what to ask anyone before having a decision.

Applying to medical school is overwhelming, full of hidden costs, unexpected requirements, and unspoken rules. From the MCAT to situational judgment tests, crafting strong letters of recommendation, and meeting program-specific prerequisites, there’s so much to juggle.

What I’ve learned is that research and preparation are everything. Know what schools are looking for, stay on top of deadlines, and don’t be afraid to ask for help from mentors or peers who’ve been through it. Whether it’s budgeting for the application cycle, sending a letter of intent, or writing secondaries, every detail counts.

This process is stressful, but it’s also doable. With the right planning and mindset, you’ll navigate the chaos and take one step closer to your dream of becoming a doctor.