The path from college to medical school and residency is not always a short one. In fact, more than a few spend years doing something else before beginning their medical training.
Two University of Colorado Department Medicine internal medicine residents are among many “nontraditional” trainees on the CU Anschutz Medical Campus and at medical schools nationwide. Both say that what they did before has helped them be better at what they’re doing now.
Fourth-year resident Kira Grush, MD, was a middle-school English teacher and, later, a dean of students at a Denver school before pivoting to medicine. “I definitely draw parallels between being at the bedside and being in the classroom,” she says.
And first-year resident Erin McArthur, MD, PhD, worked in bioengineering. “In engineering, you’re trained to be thorough and collect all the information you can to inform your path forward. And that’s often the case with medicine as well.”
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Both seek to be involved in innovation in ways that draw on their backgrounds. And both say their gap between college and medical school brought benefits.
“Going straight from being an undergraduate to medical school to residency to a medical career, for me, would have been really challenging,” Grush says. “I spent a lot of time in my first career discovering who I am and what my passions are. And so when I started medical school, I didn’t carry with me any doubts when things got hard. I felt like this was exactly where I was supposed to be, having had that prior experience.”
Says McArthur: “Many people who start medical school when they’re 21 right after college haven’t had a chance to live on their own. I needed time to figure out how to function in society and set priorities. I think people can be better prepared to jump into the demands of medical training if they’ve had time off.”
‘It’s much more common’
Nontraditional medical students and trainees are not an oddity. The Association of American Medical Colleges (AAMC), which each year surveys thousands of matriculating medical students, says that in 2023, 51.6% worked at another job between college and medical school, 25.2% entered med school three or more years after graduating from college, and 8.4% did not decide to study medicine until sometime after they received their bachelor’s degree.
“It used to almost seem like a failing if you couldn’t get everything ready to go in your last year of college so that you could start medical school right away,” McArthur says. “Nowadays I think it’s much more common to take time off.”
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In the CU School of Medicine’s Class of 2028, the average age of matriculating students was 24, close to the national norm, but the class ranged in age from 21 to 36. The AAMC says nationwide in 2023, 11.6% of first-year med students were ages 26 through 28, another 5.6% were over age 28. Ages ranged as high as 62.
It’s not always easy to make a later shift to medicine. According to an AAMC report, older students often struggle more on their MCAT exam because of their longer absence from college, and they sometimes lag academically in their first two years of med school before catching up with their classmates. But the report also says med school admissions officers value the additional life skills that nontraditional applicants have acquired.
“My story – the work I did in education and the varied communities of people I was able to work with – made me a competitive medical school applicant,” Grush says. “I didn’t have amazing MCAT scores and I didn’t do a bunch of research, but I had this connection to the community and this passion for equity.”
Kira Grush, MD, during her medical training journey. Photos courtesy of Kira Grush.
A forever Coloradan
Grush is co-chief internal medicine resident this year. A Boulder native, she calls herself a “forever Coloradan,” having received her undergraduate degree in biology from Colorado College in Colorado Springs in 2010, her master’s in curriculum and instruction from CU Denver in 2013, and her MD from the CU School of Medicine in 2021.
When Grush entered college, she considered medicine as a career path, and did some pre-med training, but she decided that “I had more of a social justice mission to what I wanted to do.” After a two-year stint with the Teach for America program at an Aurora school, “I fell in love with education.”
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Grush spent two years as a teacher with a charter school in Aurora and another five years in the DSST Public Schools network of charter schools in Denver, eventually rising to a leadership role.
Eventually, she says, “I learned I could have an impact in my goal of uprooting systems of injustice in many different ways, including health care. I felt like my initial drive and passion towards medicine, my love of science and lifelong learning, and the social connection that comes through being a doctor was more in line with what I saw myself doing long term.”
Doctors as teachers
Grush says her education leadership experience has paid off in her medical role. “I did a lot of coaching of other teachers and helping with curriculum design, which has helped me with designing small parts of the medical school curriculum and teaching medical students and residents.”
Doctors are also teachers, she says. “My experience has helped me be at the bedside and explain things to patients,” she says. “I still find myself drawing on a whiteboard and explaining to patients what’s happening inside their body.”
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And Grush also draws on her experiences in working with students and families from a variety of backgrounds. “I’m currently the Denver Health chief resident, and my great passion is working with that diverse population of patients.”
While Grush says she loves the clinical aspects of medicine and working to become “a really good doctor, I see myself doing additional work besides direct patient care, specifically in medical education and also health equity. I’m interested in trying to develop a curriculum to mitigate some of the secondary trauma folks can experience as they go through medical school and interact with patients for the first time.”
Left: Erin McArthur, MD, PhD, in the lab during her medical training. Right: McArthur in 2014, repairing medical equipment in Hondurus during her previous career. Photos courtesy of Erin McArthur.
A focus on diagnostic tools
McArthur, a first-year resident originally from Maine, became an intern in the CU Division of Internal Medicine’s physician scientist training program this year, moving to Colorado with her husband and two small children. She’s on track for an infectious-diseases fellowship with a research interest in developing new diagnostic tools.
Originally, becoming an MD was not in McArthur’s plans. But in the seven-year span between picking up her BS in biomedical engineering at Tufts University in Massachusetts in 2012 and entering medical school at the University of California, San Diego, in 2019, McArthur was busy learning and working in areas adjacent to medicine.
After college, she worked at a company that developed silk-based implantable reservoirs for delivering localized chemotherapy. Later she became a research associate at Diagnostics For All, a nonprofit biotech company mostly funded by philanthropies.
“The focus was developing low-cost, point-of-case diagnostic assays,” tests that analyze biological markers for disease, McArthur says. “I worked mainly as an engineer on a disposable type of liver function test for patients in places like sub-Saharan Africa who don’t have access to hospital equipment and analyzers.”
Wanting to further her work in diagnostic development, McArthur in 2015 entered the international NIH Oxford-Cambridge Scholars Program (OxCam) for biomedical research scholars. She did her PhD at Oxford developing a drug-use sensor to track how the use of anti-malarial drugs in Southeast Asia might be contributing to drug resistance.
Data and art in medicine
While in the OxCam program, “I worked with some MD-PhD advisors who helped me see how an MD-PhD pathway is exciting,” McArthur says. “You get to do both: The assay development and the engineering in the lab, and also have exposure to the clinic to understand what kind of tools are needed there. Upstream, you can see how those tools fit in a clinical workflow, and downstream, you can actually see the tools used in a clinical setting and be involved in implementation and testing. So that was what led me to apply to medical school.”
Now, as a clinician, McArthur is learning to bridge the gap between the precision of engineering and what she calls “the art of medicine.”
“Blame it on my engineering training, or maybe it’s just my personality, but I am very detail oriented,” she says. “I want all the data to make a decision, and sometimes in medicine you don’t have that. Medicine is mostly based on large studies that inform our guidelines, but sometimes it’s not so cut and dried. So you have to fill gaps and be able to find a path forward.”
And there’s another new element to her work that didn’t come up while studying engineering, McArthur says. “The type of people who study engineering are perhaps less of the social type, or that’s the stereotype. But in med school, you get a lot of training in how to have conversations with patients. We have so much exposure to it that I haven’t found it hard. In fact, I really enjoy the interactions with patients. It’s what make medicine fun.”
She adds: “I have two young kids now and doing that in clinical training is hard. So there are downsides to waiting. But there are a lot of upsides as well.”
Advice to others
Asked what they would tell others who might be interested in pursuing medicine as a second career, Grush advises “reaching out early for counseling on the medical school application process. For example, I didn’t know that you should submit your medical school application on day one, and that if you submitted it later in the application window, you’re basically not going to get an interview. I did have to apply to medical school twice.”
Says McArthur: “Once you start on the medical school/residency pathway, there will be many years of training where your life is not your own. You’re working 70-plus hours a week and you never know when you’ll have days off. And that’s probably not typical of other jobs you may have had before. So I tell anyone interested in medicine that it’s important to have life experiences beforehand, and to figure out what you really want to do.”
Photos at top: Kira Grush, MD (left), and Erin McArthur, MD, PhD.
