For the next few months, Michelle A. Narváez Ramos plans to spend Sunday afternoons curled up on her couch, her laptop open, reviewing packet after packet of medical school applications.

A sixth-year student in the MD-PhD program at UMass Chan Medical School in Worcester, Massachusetts, Narváez Ramos will help determine who will get one of the coveted spots in next year’s class. Last year, there were more than 8000 applications for some 225 slots in the MD-PhD and MD programs.

Most medical schools involve their own students in admissions, but their roles vary based on the program. They often serve as interviewers or vote on admissions committees. At UMass Chan Medical School, students don’t participate in the initial application reading or screening, but they can volunteer to interview applicants. A total of 12 students also sit on the 54-member admissions committee. They serve for 1 year and have the same voting rights as faculty and nonstudent members.

The committee members team up; Narváez Ramos was paired with a faculty member. Each pair is tasked with reviewing a set of applications, discussing them, and then presenting them to the larger group. There is a structured rubric for reading applications.

When Narváez Ramos combs through applications, she starts with their essays.

“You have to be someone who is empathetic, can relate to people on different levels, and that can communicate effectively,” she said.

More than 54,600 people applied to US medical schools last cycle, a 5.3% increase from the year before, according to the Association of American Medical Colleges (AAMC). The resulting class included 23,400 students, the largest number to date.

The process is facing heightened scrutiny this year, after the U.S. Department of Justice opened investigations into more than 15 medical schools to examine potential racial discrimination in their admissions. The probes, part of the Trump administration’s crackdown on diversity, equity, and inclusion, have revived questions over how to select medical students, including which qualities — academic merit, personal traits, or otherwise — lead to the best doctors.

“We’re hearing this false dichotomy articulated between merit-based and holistic, and those two things are not in opposition to each other,” said Tracy Kedian, MD, associate dean for admissions at the T.H. Chan School of Medicine at UMass Chan Medical School. “They have to be able to take the tests, and they have to be able to talk to people. It’s all merit.”

The Road to Medical School

Back home in Puerto Rico, people assumed that Narváez Ramos would pursue medicine; she had always liked science and gotten along well with others. An optimist and perpetual learner, she taught herself skills such as cooking or subjects such as zoology. Medicine offered a lot to explore.

But shadowing clinicians left her disheartened by how often treatments for critically ill patients run out. After that, she started spending more time in research laboratories, too. “Research offered hope for better and more targeted treatments, and I wanted to be part of that.”

Narváez Ramos applied to medical schools in 2020 directly from her undergraduate program, where she studied microbiology and did research at the University of Puerto Rico in Mayagüez, Puerto Rico. Even with her experience and guidance from mentors and other students, the admissions process felt opaque.

“It’s really stressful,” she said. “You never really know if you’re enough and how you match up with others.”

Narváez Ramos received multiple offers but chose UMass Chan Medical School because of its location and the population it serves. Many Worcester residents speak Spanish, and Narváez Ramos thought she could be especially helpful there.

As a student, she applied to join the school’s admissions committee, wanting to learn more about the process and serve as a voice for other aspiring students, particularly those who might have had fewer opportunities or less support.

What It Takes

For applicants, academic grades and Medical College Admission Test (MCAT) scores are often the first step. In 2025, matriculants across US medical schools had a mean grade point average (GPA) of 3.81 and a mean MCAT score of 512.1, up from the previous year, according to the AAMC.

There is a strong connection between MCAT scores and early medical school success, studies suggest, and using MCAT scores and GPA together is an even more accurate predictor. MCAT scores are also linked to how well students do on licensing exams. But at least one 2015 study found that the MCAT cannot predict clinical performance or success after graduation as easily.

“For someone to practice medicine well, they definitely have to have a baseline ability in terms of their intellectual capacity, in terms of their ability to reason,” said Jessica Freedman, MD, founder of the consulting company MedEdits Medical Admissions. “But then I also think they need to be compassionate. They need to be really strong communicators.”

The AAMC has a list of premed competencies that span scientific knowledge, thinking and reasoning, and professionalism — characteristics including empathy, teamwork, and interpersonal skills. Many such traits are less tangible and more difficult to quantify or study than test scores. Instead, Narváez Ramos and other reviewers glean them from essays, letters, and interviews.

Academic readiness remains at the core of success, said Geoffrey Young, PhD, AAMC’s senior director for Transforming the Health Care Workforce. But that doesn’t mean those with the highest grades or scores on standardized tests will become the best physicians.

“If I were to ask someone, what are the characteristics of a doctor that you truly connected with and trusted and felt like they were really providing the best care possible? I don’t believe someone would say it’s their test scores,” said Young.

Medical schools also give preference to applicants who align with their missions, whether that means fostering the medical workforce in their states, boosting biomedical research, or providing care to rural communities. At UMass Chan Medical School, its mission includes a focus on community service and healthcare equity, including through research or work with diverse populations.

UMass Chan Medical School’s home city of Worcester is incredibly diverse, Kedian said, with more than 85 languages spoken by families in its public schools. “Students who speak a language get extra points because they bring a value-added skill to patient care.”

Sifting Through Files

By the time a file appears on Narváez Ramos’s laptop, the applicant has already made it through the initial review. At that stage, the applications have already passed the academic bar, so she doesn’t lean heavily on their grades or their MCAT scores.

Being a student herself has helped Narváez Ramos empathize with the applicants, she said. In a process with seemingly endless hoops to jump through and constant online voices doling out advice and advertising accomplishments, how do you stand out?

To that end, Narváez Ramos tries to get a sense of where the person is coming from, the opportunities they did or didn’t have, and how they responded to adversity.

“I’m not looking for a specific checkmark on their race box,” she said. “I’m looking for someone who as a whole can relate to a patient and be curious and be a good healthcare professional.”

Narváez Ramos and her fellow volunteer reviewers at UMass Chan Medical School don’t see demographic information such as sex, race, or where they went to college.

Instead, they dig through the rest of the applicant’s file, seeking students who have embedded in medical settings, laboratories, and their communities.

“I’m not looking for someone who checked a lot of boxes in premed and then can’t talk about experiences,” Narváez Ramos said.

To go into medicine, a person should be a curious learner and a patient teacher, she added. They need curiosity to keep up with constantly changing guidelines and drugs and to make connections between symptoms and lab results when the diagnosis isn’t immediately clear.

“A good doctor will be able to digest the information in the patient history, labs, and imaging, and present it to the patient in a way they will understand it,” Narváez Ramos said. “Doing this is important not just for a positive doctor-patient interaction but for good health outcomes.”

The people quoted in this story reported having no relevant disclosures.