'Abysmal' Student Makes the Grade as Oncologist

Better late than never, 10 weeks before his scheduled graduation from the University of Wisconsin in 1986, college student Kurt Oettel had his first and only meeting with an academic advisor.

In his hand, he had an envelope with his undergraduate academic records, including his weak grade point average (GPA) of 2.5 and undistinguished Medical College Admission Test (MCAT) results.

The young Oettel confirmed that he was a pre-med student. The academic advisor was blunt about his medical school admission chances: "It appears, son, that you are in the 5% range — the bottom five."

My academic performance was "abysmal," admitted Oettel while telling his tale of career struggles and successes as part of ASCO Voices. The storytelling event recently took place during the Educational Sessions portion of the 2020 American Society of Clinical Oncology annual meeting, held online this year because of the pandemic.

Oettel, a medical oncologist who is now director of the Gundersen Health System Cancer Center in La Crosse, Wisconsin, told the virtual ASCO audience: "I should not be here — really I shouldn't — and I shouldn't be talking to you. Yet here I am."

In the remainder of his talk, Oettel described a set of pivotal events and personal traits that, over time, took him from being a very unpromising pre-med student to an accomplished doctor.

His story also raises questions about the weighted importance of grades and test scores among medical school aspirants. The undergraduate average GPA for medical school matriculants is high. For example, in 2017–2018, it was 3.71 overall (for both science and non-science courses combined) — a number that Oettel, with 2.5, fell well below.

Collector of Worms

Even before his deflating meeting with the academic adviser, Oettel knew he needed something in addition to grades and scores to get into medical school.

So, while still an undergraduate, he got practical experience: an emergency medical technician (EMT) license and a job working at a cancer center doing administrative work.

And then he got "the worm job."

The position seemed suited to his career ambitions; it involved the study of neurotransmitters at a neuroscience lab at the university. The research subject was a worm chosen for its simplistic, 200 neuron system. However, the actual work he was given was humbling, very humbling.

"My expectations were crushed. I would not be assisting in cutting-edge research. Nope. I was to be the collector of worms — intestinal parasites from freshly killed hogs," he explained.

While still attending classes, Oettel regularly drove to a slaughterhouse and searched for "those precious worms" while "elbow deep" in warm hog intestines in a large stainless steel tub.

"Funny thing is, I was good at it!" Oettel recalled.

He stuck with the job for 2 years — until graduation. Oettel made an impression on the lab director, who gave him a letter of recommendation and a set of contacts of his colleagues. "There was one glitch — his colleagues were all in the UK," Oettel added.

Luckily, after a steady stream of rejections, the Wisconsinite got a job in Professor Avrion Mitchison's lab doing tissue culture work in immunology at University College London.

Oettel went from being a kid just out of college in the Midwest to working with an established zoologist and comparative anatomy researcher in the capital city of the United Kingdom.

But Oettel kept his eye on the prize: medical school acceptance. "I basically devoted the next 5 years of my life making up for the [previous] four," he said, referring to his misspent college years.

A committed grinder at this point, Oettel "settled into a yearly routine" of sending in medical school applications each fall, taking grad classes, publishing scientific papers, and then in the spring and summer, receiving rejection letters and retaking the MCATs, followed by "collapse and repeat."

Finally, 5 years down the line, he got into medical school — at his alma mater, the University of Wisconsin.

Oettel's current appointments include principal investigator, Wisconsin NCORP (NCI Community Oncology Research Program); executive committee member, Eastern Oncology Cooperative Group (ECOG); chair, ASCO State Affiliate Council; member, Board of Medical Governors, Gunderson Health System.

But the worm job — and not his later professional triumphs — was the focus of Oettel's most extensive comments during ASCO Voices. "I have learned that opportunity doesn't always look like opportunity," he said.

The worm job taught him to give of himself "above and beyond, no matter the perceived reward or lack thereof," he added. "One can never know where such endeavors end."

His career path, which essentially started in a slaughterhouse, reinforces his belief that "I really am above nothing. No job is beneath me."

Oettel's biggest obstacle on his path to success, he said, was himself. "Yes, I've met the enemy and it is I," he said, alluding to a famous line from the American comic strip Pogo by Walt Kelly.

In a comment perhaps fitting for an ex-worm digger, Oettel said what matters most is not the start or finish of a career, but the "messy middle," a reference to Brené Brown's book about perseverance, Rising Strong . That place is "where the magic happens — the sifting and winnowing, the late nights, the early mornings, the endless repetition of getting it right…and never losing sight of the goal, no matter what," he asserted.

"The road…has been tumultuous, delayed and full of detours. It's not what I envisioned," he admitted.

Oettel then added: "If it weren't for where I've been, I wouldn't be where I am."

Academic Performance and Destiny

Oettel's talk touches on the importance of two highly influential measures of a medical school applicant's status: GPA and MCATs.

Roughly 60% of medical school applicants do not get in, according to 2019 report from the Association of American Medical Colleges (AAMC). And because there is a high volume of medical school applications annually in the US, admissions officers make initial screening decisions based largely on undergraduate GPA and MCAT scores, according to the Princeton Review, the prominent US scholastic test advisory service.

"Generally speaking, your undergraduate performance is the most important aspect of your medical school application," according to the review, which may explain Oettel's initial failure to get into med school.

However, a 2016 study may argue for a strategy of not restricting medical school candidates by grades and test scores alone.

In that study, researchers at Vanderbilt School of Medicine, Nashville Tennessee, examined 153 enrollees in its MD-PhD training program between 1963 and 2003 and a related set of variables such as graduate school grades, United States Medical Licensing Examination (USMLE) scores, and career accomplishments. The team concluded that "MCAT score and undergraduate GPA were inconsistent or weak predictors of training metrics and career outcomes for [a] population of MD-PhD students" at their institution.

There has been a push in the US to reform the testing required for medical school entrance. "The MCAT cannot gauge many factors that make a good physician" such as interpersonal skills, say the authors (a prospective medical student and a psychiatrist) of a recent essay published on Medscape. More than 35 American medical schools now require or are considering imposing so-called situational judgment tests (SJTs), the pair point out. But these tests are not likely to improve diversity, they also assert, because disadvantaged students still score lower on these tests.

As a result of the COVID-19 pandemic, there were calls earlier this year to suspend the MCAT requirement for medical school applicants because of the hazards of on-site, group testing, as reported by Medscape Medical News.

But not even a pandemic stopped the test; the decision to proceed was explained by its governing body, the AAMC, in an open letter to MCAT takers.

Dr Oettel has disclosed no relevant financial relationships.

Nick Mulcahy is an award-winning senior journalist for Medscape. He previously freelanced for HealthDay, MedPageToday and has had bylines on WashingtonPost.com, MSNBC, and Yahoo. Email: nmulcahy@medscape.net and on Twitter: @MulcahyNick

For more from Medscape Oncology, join us on Twitter and Facebook

Medscape Medical News © 2020 

Cite this: 'Abysmal' Student Makes the Grade as Oncologist - Medscape - Aug 18, 2020.