Tribute to Dan Marien

When I reflect back on Dan, I do not see a skeptic as he often termed himself.
What I see in Dan Marien are pieces that are now an integral part of me and I am sure, of all of us, his conscience, his depth, his strength of purpose.
I see them all now reflected back more clearly in his death, so much so that I feel like a plagiarist.
How did he ever survive so long with the level of awareness that he had, and shared?
I am humbled again by those I am privileged to know via this list (HLTHPROF)
I didn't plan to miss Dan so much...

Dan's thoughts over the years, from my web site where they are posted by permission from Dan.
Taking short cuts doesn't seem wise, no matter how attractive it may appear. Nibbling at the bait often proves lethal to mice, roaches and other unwary creatures, even some premedical students.   Dan Marien
Attitudes toward coaching students for interviews, helping them with personal statements, etc. depend in part on the composition of the student body. Some of us have many students who never interviewed for anything much more exalted than a job in a supermarket, if they even had to interview. Many of
us are at colleges where personal statements or admissions interviews are not required. Many of our students have little clue to the social skills that will be demanded of them as physicians because they come from non-professional families. Many do not understand why they should have medically-related experience except that they heard it looks good on the application. And join clubs.
We are advisors. I take that to mean much more than handing students a list of courses to take, a timetable for application, telling them to get recommendations and hey, good luck kid. You don't just dump people into high school, college, professional schools and say sink or swim, you're on your own.
I helped my students with everything including curriculum advice each semester and what to do when they were running into academic or personal problems. They often made the wrong choices about all of these things. They listened to premed scuttlebutt without realizing that what is sauce for the goose is not necessarily sauce for the gander. I proofread personal statements and suggested where to apply. Each student is an individual and the same solutions are not always the same for each.
I own up that I was able to do all these things because I was faculty, with a reduction in teaching hours for the advisor job, I had a full-time secretary who came early and never left early, I lived walking distance to work, and I had the support of the Administration. I worked a five day week because I
chose to.
Some of you will understand me and agree, others will strongly disagree. What is "ethical" behavior in advising is open to some discussion, although I recognize there will be limits we can all agree on. We can expect no unaminity on a job that is situational, has no universal job description nor any
formal training. The closest we come to that occurs at NAAHP and regional meetings where we learn from each other.
Dan Marien   Polished vs Unpolished Applicants
On the College Advisor Role
Although the particular case which aroused so much comment would seem to be settled, I think perhaps there are three general issues still to be faced.
One is the differences among colleges in grading scales, in the present example between those that use plus and minus grades and those that don't. In the C range case discussed, it would seem advantageous to take courses at a school which did not use the +/- system. On the other hand, for students whose grades are often in the upper ranges of a grade interval, the +/- system would carry an advantage for some.
Opening another can of worms, in theory using grades "objectively" assumes that an A, is an A, is an A. Anyone who has ever been a student or has ever worked in Academe knows this not to be true. There is no such animal as a national, uniform, completely objective scale of grading, invariable from college to college, department to department, course to course, instructor to instructor. Even within single departments, one instructor's criterion for A may differ from another's. Thus, grades too are judgment calls. I won't belabor the point further.
The third issue is that of having rigid cutoffs, i.e., C-, although passing, as not acceptable. Being someone who looked at everything in a student's academic record such as pattern of course choices each semester, other demands on a student's time,
responsibilities, unexpected contingencies, etc., and recognizing that high grades alone are not necessarily the best measure of intellectual competence nor of suitability for becoming a health professional, my evaluation and support level was never based on rigid categories. C- is not a good grade, but it is passing, and a single C-, maybe even two, in an otherwise good record should not necessarily be ground for non-support. And all the more so if there are otherwise very positive aspects of a student's candidacy for a professional education. Belief that context is important in evaluation, I always tried to look at and present a whole picture. 
Although it is expensive, time consuming, a drain on human resources and not always effective, I believe that the US system (especially requiring letters and the interviewing of applicants) for selecting students for admission to medical school is appropriate. We
hear often enough that we want to turn out more than technically competent physicians. In my opinion, for that goal to be achieved we must begin with more than technically (read academically) competent medical students.
Judgment calls everywhere. The downside: 'Tis with our judgments as our watches, none go just alike, yet each believes his own.     Alexander Pope: Essay on Criticism
Dan Marien
Since I have so many opinions on almost everything else, why not one on "shadowing"? [Don't reply, please, the question is rhetorical!]
I always believed the main purpose of medically related experience is for prospective medical students to learn about themselves in the context of what they are planning to do in the future. It is not to learn medical techniques: that they learn in medical school and after. In the inward journey of learning about themselves they must also learn about patients as human beings, not cases, about physicians, nurses, and all others involved in health care. To do this the student partly should be like a fly on the wall, unnoticed but observing everything. At other times, when appropriate, students should speak with patients and the others to listen to their feelings, hear their experiences, attitudes, perceptions, opinions. All of this is then for each student to ponder, examine her/his own feelings and perceptions in the context of answering the questions: is this what I really want to do and am I suitable for it?
A fly on the wall is neither handling patients nor being charged for having this opportunity. The reward is an opportunity to confront reality, not dreams of glory. It is this inner journey that is important.
Daniel Marien
In February, 2001, Dan Marien wrote:
What use is he going to make of that simple raw statistic? Let me guess: if the national rate of acceptance to medical school is, say, 50%, then if Augustana is not getting 50% of its applicants into medical school the advisor must not be doing the job?
Some years ago a father and daughter showed up in my office and the only question was "what percentage of our applicants get into medical school." My first response was to tell him the question is meaningless. If all our applicants, however many there were, had high grades, high MCATs, applied to a reasonable mix of medical schools, applied in a timely fashion, had good recommendations, had whatever other qualities were valued, and interviewed well, we would have a 100% acceptance. If your daughter did not meet those standards the year she applied, she would not be accepted. If your daughter was the only one of our students in a particular year who met those standards, she would be accepted even if she represented only 1% of our applicants. I tried to explain to him some of the many other sources of distortion (other than outfight puffery) in figures given by various colleges. I tried to explain to him that a more important question was to try to determine how well his daughter might function in different college environments. He kept harping on the one thing that interested him. Exasperated, I told him if he wanted to send her to a college with a high acceptance rate, send her to Harvard. I never saw them again. My own college's PR office kept after me with that same question. I told them pick any percentage figure they liked, it was meaningless. I never looked to see what the brochure said. When a student asked me that question on acceptance rate, I explained how to be a good student, how to be a competitive candidate, and that if he/she did it all right, he/she would get into medical school.
Personally, I have always taken with a grain of salt the % acceptance reported by colleges. Part of the reason is that I am an insider and I learned how various colleges deal with applicants. Some of them, if the students do not measure up to some academic standard as almost the only criterion for recommendations, refuse recommendations and conveniently the expected losers don't appear in the denominator. Others use the AAMC report for their own college and will count in the numerator students who took only a summer course there and were accepted.
There are so many different variables that play roles in acceptance/non-acceptance that I believe the percentage figures should be somewhere near the bottom of the list when students consider where to attend college.
Deans have other pressures on them so that many are not interested in these nuances; just the statistics, and they damn well better be good; don't bother me with these details.
Good luck to you, Bob.    
Dan Marien, the skeptic
Message from Dan:
Although I was born and lived in New York City almost all my life, and I am not that far away in retirement, I am appreciative of what you are doing and proposing. However I am saddened by the likelihood of your message falling on deaf ears, shut eyes and closed minds. Did I tell you I was born a pessimist and expect to die one?
Maybe it is different outside of the big metropolitan areas, but what I see is an increasing number of immigrants to the US whose children see medicine as prestigious and look forward to the income they will earn. Sadly, this is also true of too many native born Americans. They speak of medicine as a "calling" and speak and write only of "saving lives." Most of them are fixated only on grades and MCAT scores, and can they get into a "prestigious" medical school.
I long ago learned that high grades and high MCAT scores do not necessarily a good physician make. When I wrote the letters of evaluation, the warmest and strongest were for what I called "good people", regardless of academics. 
I wish you success in your endeavor. It is badly needed.
Dan Marien
Dan's posting:  Instead of all too frequently inviting speakers from medical and other professional schools on admission to their schools, maybe it would be more useful for preprofessional clubs to discuss or invite speakers to discuss items such as this, a far cry from most premeds concept of going to medical school to "help people."  Dan Marien, Health Profession Advisor
Just a few of the articles Dan clipped that taught us about Higher Education, Life in the United States, and Being Better Humans, and Physicians:
NYTimes.com Article: Boston Medical Center Turns to Lawyers for a Cure  By CAREY GOLDBERG   BOSTON, May 15 Turning to Lawyers for a Cure
Learning Beyond Measure From Article by RICHARD R. BEEMAN through list serve at HLTHPROF PHILADELPHIA  When the U.S. News & World Report annual rankings....
Learning Beyond Measure
Ken Iverson is indeed a modern day Maimonides for the premedical student! I have recommended his Guide to the Perplexed from the moment I first saw it years ago. It even covers such information as to how to properly pack a bag for traveling to interviews! I never recommended any the many other "how to" guides.
Going to professional school interviews is an art in itself. The long road to applying to medical school is itself time-consuming and for most costly, financially and otherwise. The medical school phase is itself costly and time-consuming. Getting into medical school is worth the additional expense of doing the job properly, and should be considered part of the cost of admission--to medical school, that is.
Too many students consider it a hit and run proposition: arrive at the last minute, leave as soon after as possible. I always believed it should be at least a three day affair: arrive the MORNING of the day before and spend it at the medical school speaking with medical students about the interview, the curriculum, teaching, housing, costs, local transportation, the inner and external school environment, what they do for fun, anything else of concern to the applicant. Arrive early the next day well prepared for what to expect. If it seems warranted, stay over another night and revisit to resolve other questions which may have arisen and to confirm impressions of the day before.
The benefits are many. In choosing a medical school the VERY LAST item on the checklist should be "prestige." Happy campers do best, and students who end up at or near the top of the class are most likely to be those who get the residency they seek.
Daniel Marien 
When I reflect back on Dan, I do not see a skeptic as he often termed himself. 
What I see in Dan Marien are pieces that are now an integral part of me and I am sure, of all of us, his conscience, his depth, his strength of purpose.
I see them all now reflected back more clearly in his death, so much so that I feel like a plagiarist.
How did he ever survive so long with the level of awareness that he had, and shared?
I am humbled again by those I am privileged to know via this list.
I didn't plan to miss Dan so much...
Other Heroes in Medicine
Bob Bowman
 
Advice About Getting Into Medical School
Acceptance Rates to Med School
Admissions Ratios and US Medical Students
Attrition Rates
www.ruralmedicaleducation.org
 
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