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smart enough and dedicated enough to have good grades and do well on the MCAT, sure, but determination is a major factor. And some physicians are very narrow in their interests, poorly informed about other things, or have lousy personalities. Why do you think so many are Republicans? ;-)
Most med schools only accept in-state students (in Dean's case, NY was his home state and he went to med school in NY) but most med school applicants apply to all the in-state schools and some out-of-state schools, too. Since so many apply to schools that they haven't a chance of getting into, the rejection rate is high. Thus, the myth that it's next to impossible to get into med school. But many who are rejected by some schools are accepted at one of their in-state schools.
Many others are accepted to med school the year after they finish college -- or the year after that. One guy I went to undergrad school with completed a nursing degree and worked as a nurse for a year or two before finally getting into med school. He was serious about medicine and he proved it. Many just settle for dental school or chiropractic school if they don't make med school on the first try. (Some aren't very serious, anyway, but are going into medicine to please the parents.)
A major factor in getting into med school is the interview. Many students have good grades and good MCATs but bomb their interviews. I read an article that said that the admissions guy at Albert Einstein Medical College was very impressed with Howard Dean -- still remembered him after all this time. As I recall, he had been doing volunteer work in a hospital, something that always goes over well with med school admissions people. So Howard interviewed well and that overshadowed his grades at Yale (which I believe that I've read were mediocre.) Before applying, he took several science courses, which probably helped his MCAT scores considerably. He might have taken one of those coaching courses for the MCAT, too. Most "pre-meds" take those courses.
Some physicians will admit that getting into med school was harder than getting through med school. They work you hard in med school but my old lab partner in organic chemistry went to a prestigious private med school and he told me that once you're in, you realize that C = M.D. In other words, you no longer have to try to get the highest A in every class. The guy (or gal) who's last in the class will still be an M.D. Physicians-to-be also learn in undergrad school to get in study groups with the smartest people they can. I wouldn't be surprised if Howard had a study group, or perhaps just studied with his girlfriend (now his wife and an M.D. herself.)
As a group, doctors are smarter than average but their intelligence is also overestimated. I think this applies to Howard Dean, M.D., as much as any other physician.
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