Is there always the chance that, even if I work hard, I won't get in med school?

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They are strict IMHO! DS took at least one music class every semester in his first 3 years in college (We actually encouraged him, a science major, to do that.) I do not think he was disadvantaged while he was applying to medical schools because of this. Actually, I think it helps because medical school adcoms might think he had life besides academics. Heck, in the admission letter (actually it is a video) to one school, the adcom complimented him about his achievement in this particular non-academic area. (He was good enough to perform at a school-wide event and earned a lot of money for his favorite charity organization over multiple years because of this hobby. He also made friends who share the same interest relatively easily because of this hobby when he set his foot on campus initially.)</p>