EACH YEAR, THE SCHOOL OF MEDICINE admits 120 first-year students after a months-long winnowing process marked by difficult, often painful, decisions. Of the nearly 4,000 applicants, the Committee on Admissions invites 1,100 or so to campus for interviews, then offers admission to 300-310. Ultimately, the yield from those offers is 1 in 2.6 — making Washington University’s medical school the most selective in the nation.

How to make such tough choices? “We run the admissions process as a talent search,” says W. Edwin Dodson, MD, committee chairman and associate vice chancellor for admissions. “We are not in the business of rejecting people; we are trying to find the best. By the end of the year, we have found them.”

W. Edwin Dodson, MD, associate vice chancellor for admissions, and first-year student and class president Derek Williams peruse the school’s annual Study of Medicine student recruitment brochure.

Among the candidates this year is a young man whose stellar achievements indicate just how talented applicants can be. A straight-“A” student from a top eastern school, he has served as an emergency medical technician and a combat medic in the National Guard. He took a year off to teach school. And he and his father belong to the High Peaks Club, having climbed the tallest mountains in 15 states and counting.

In a recent newspaper article, says Dodson, one current student described what it was like to have such accomplished classmates: “I enjoy learning medicine in the company of the poets, painters, engineers, opera singers, philosophers, photographers, biochemists, and dancers who compose our class.” Adds Dodson: “And it’s true; it’s really true.”

Yet it has not always been this way throughout the medical school’s history. Since 1891, when the St. Louis Medical College affiliated with Washington University and became its new medical department, the School of Medicine has gradually attracted a larger, better educated and more diverse student body.

Early Days

In September 1891, a Student Life writer attacked medical schools for admitting “almost anyone no matter how inferior his previous training.” Every year, the writer said, ill-equipped young doctors “are let loose upon the world… A host of them go about dispensing their poisons — a danger to the community. There ought to be a higher standard of admission to…medical schools, generally.”

Soon, there was. On his whistle-stop survey of American medical schools for the Carnegie Foundation, Abraham Flexner visited the School of Medicine to see how it stacked up. His findings — that the school was “absolutely inadequate in every essential respect” — angered Washington University’s board president, Robert S. Brookings.

So Flexner came back a second time to show Brookings just how bad things were, including the admissions process. Later, Flexner wrote:
“We went to the dean’s office, and I asked to see the credentials of the students of the school, for the school pretended to require a flat four-year high-school education of all entering students. It was quickly apparent to Mr. Brookings that no such requirement was being enforced.”

Shortly, Brookings embarked on a top-to-bottom overhaul of the school, while also targeting admissions. Little by little, the requirements increased: from one year of college work in 1910 to two years in 1914, three in 1925, then an undergraduate degree in 1929. Class sizes also burgeoned, from 60 entering students in 1910 to 75 in 1921, 82 in 1925, 109 in 1970 and finally the current 120. Women were admitted in 1918; officially, segregation ended in 1947, though the first black student did not graduate until 1962.

The 1940s–50s

Charles Parker, MD 53, recalls the month-long train trip his father — William Parker, registrar for nearly five decades, beginning in 1925 — made each year to interview prospective students. While other members of the Committee on Admissions claimed the east, midwest or south as their recruitment areas, Parker focused on the northwest and southwest, traveling to Montana, Idaho, Washington, Oregon, California and Texas, hitting all the major schools in those states.

Medical students take in a lecture, circa 1959.

“He interviewed virtually every medical student applicant out of the Pacific Northwest who later came here over a period of 20 or 25 years,” says Charles Parker. While the committee voted on each applicant, “I suspect that if members thought they had a particularly good candidate, they were empowered to go ahead on their own.

An alumnus originally from Montana — the top student in his undergraduate class — told me that, when he was only a junior, he had already taken his MCATs and wanted to get the admissions process over with. He asked my father if he could interview to enter medical school after his senior year — and was accepted on the spot.”

During William Parker’s tenure came the upheaval of the World War II years. Two West Coast students including George Sato, MD 47 — children of internees — were admitted to the medical school, where they worked hard to prove themselves in the face of widespread suspicion of Japanese-Americans. “We never applied for any monetary help at all; we worked at a mental institution from 5 until midnight, then studied until 3 or 4 a.m. and were up again at 7,” recalls Sato. “We kept our noses as clean as possible, because we thought they were watching us and saying: ‘If they falter, we’re not going to take any more.’”

The 1960s, 70s and 80s

In 1965, pediatrician John Herweg, MD 45, replaced M. Kenton King as associate dean for student affairs and chairman of the admissions committee, remaining on the job for 25 years. Today, a plaque honoring him hangs outside the School of Medicine admissions office. He oversaw vast changes in admissions: an expansion of the admissions committee, including part-time faculty; a shift from interviews on the applicant’s home campus to interviews held at the School of Medicine; an increase in the entering class size, and substantial growth in the applicant pool — from 3,000 to 7,000 in some years.

“Over time we had more young men and women who were academically superb, almost frighteningly bright,” says Herweg. “From that group you would find those who were likewise as exciting as individuals. What has this person done to show they care about people, have leadership skills, can relate to people in a concerned fashion?”

Through these years, admissions became computerized and standardized, with the development of the American Medical College Application Service (AMCAS). Soon medical applicants nationally were filling out AMCAS forms as the first step in the process; AMCAS compiled and verified basic information about each candidate, including grades, activities and Medical College Admission Test (MCAT) scores, and passed this data on to medical schools for further sifting.

A major new program — the Medical Scientist Training Program, developed by Roy Vagelos and his colleagues — also was introduced during Herweg’s tenure. A seismic shift occurred in another area: the growing number of women in medical classes, a trend encouraged by Herweg whose first wife, the late Janet Herweg, was herself a physician. In the 1970s, Herweg, registrar John Schultz, assistant dean for student affairs John Walters, and assistant dean for minority student affairs Robert Lee, PhD, began targeting minority recruitment.

In a 1981 article, John Schultz summed up the applicant pool: “They make up the best-qualified crop of candidates in history. If we had sufficient openings, two-thirds of them would probably be admitted.”

1990s to the Present

The same is true today, says Dodson, who took over admissions in 1990. Still, they grapple with some issues, particularly name recognition. “It’s a huge problem,” he says. “Students from the east or west coasts think we’re one of those ‘George Washington’ places — they don’t know whether we are in Seattle or Washington, DC.”

In the end, they find students like first-year class president Derek Williams, a Vanderbilt graduate who had turned up on short notice to look at the school — and was astonished when Koong-Nah Chung, PhD, associate dean of admissions, took time from her day to show him around. Since then, he has been impressed by the academic and personal qualities of his classmates.

“When a sign-up sheet is posted for neighborhood health clinics, it fills up right away,” he says. “People are here because they want to be doctors, they love helping others, and they think this is the best way in which they can help their community.”

Some students, of course, turn down the medical school, often choosing its coastal competitors. But a number will be back one day as residents or faculty members. “We see these really talented people, and we get a lot of them,” Dodson says.

“And the ones we don’t get are never really sure that they shouldn’t, in fact, have come here.”