The reason we start with themes is the same reason we suggested you start your brainstorming by thinking about your long-term vision. The overarching theme you decide on will inform the manner in which you organize the rest of your content. This theme is analogous to the thesis of an academic essay, though it's often less explicitly stated.
When we use the term "theme," we mean something that usually has multiple layers. A strong essay will never boil down to a statement as simple as the following: "My reason for pursuing medicine is X." That kind of theme would invite a repetitive structure that merely includes a series of paragraphs offering evidence for a single point. Instead, your theme should introduce complexities, as in the following: "While Experience A demonstrates my commitment to B Aspect of medicine, Experience C drives me toward Objective D."
There are essentially two ways to set forth your theme. The first is to bring it up in the introduction, usually at the end of the first paragraph. At this stage, since you haven't explored your concrete evidence, the theme should subtly indicate the direction the essay will take rather than try to tell the whole story.
The second approach is to ensure a strong flow between paragraphs, connecting each point with previous ones so the underlying theme gradually emerges. Then the conclusion wraps these individual themes together and includes some kind of encapsulation of the material that preceded it. Below we will use examples to illustrate these two tactics:
The theme of this essay comes down to the following: "Working each night, for a total of 42 hours a week, has forced me to structure for myself an educational schedule that has required more time in college than most spend. However, as a result, I will be emerging from my university experience with greater maturity, self-knowledge, and certainty about the professional direction I am choosing to follow than many of my peers." These two sentences come at the end of the first paragraph and outline the ensuing material, which will consist of experiences that affirm his maturity, self-knowledge, and certainty about the professional direction he is choosing. Ultimately the essay is still an argument for his admission, but he organizes that argument around the above qualities to make a more sophisticated case. Moreover, although these are his organizing principles, note that he still manages to discuss the relevant shadowing and volunteer experiences within that framework.
This applicant has a succinct introduction that provides a clear thematic direction for the rest of his essay: "Martial arts and medicine. They seem worlds apart, but they both have played significant roles in my life and for reasons that are surprisingly similar. They both offer challenge, require great discipline, and necessitate a goal-oriented approach." By organizing his essay around a single main comparison, the writer sets up a framework within which he will explore several qualities that he cultivated in martial arts and hopes to apply to medicine. Notice that the writer does not attempt to force a one-to-one alignment between the two areas. Despite the list of qualities he names in the introduction, he goes on to discuss other facets of medicine that appeal to him. Nevertheless, there is enough substance to the comparison that when he makes the transition to discuss medicine alone, the reader is still entirely with him. After all, the point of the essay is not to prove the connection between medicine and martial arts, but to use that connection as a way to provide insight into the applicant's background and goals.
This essay opens with the statement of an obstacle. The second paragraph recounts the applicant's manner of overcoming that obstacle. Triumph over adversity is a powerful theme, but it soon becomes clear that this essay has more layers. The third paragraph begins a new point that flows only because of chronology, but by the end of the paragraph, we see that a new theme has emerged: "I had an opportunity to observe surgeries, from mastectomies to hysterectomies and bypasses, and to see firsthand the importance of positive doctor-patient interactions. I was fascinated by everything I saw and became more convinced than ever that I could one day make my finest contribution as a physician." No explicit connection between themes comes up in the body of the essay, but an underlying progression gradually becomes evident as the essay continues adding evidence in this manner.
Finally, the conclusion ties things together more explicitly: "My commitment to becoming a doctor, and my excitement over the prospect of being able to serve others in this capacity, is what has driven me and kept me going in the face of so many obstacles since my departure from Russia. Now, with my goal in sight and so many recent experiences reaffirming my passion for medicine, I know that all of the dedication and sacrifice have been worthwhile." Although this essay began by detailing a specific obstacle, we now see that the overarching themes deal not only with perseverance and commitment but also the act of confirming that commitment through hospital experiences, of which patient service was the most significant part. Again, the theme cannot be summarized in a simple sentence, but that only means there is real depth to his ideas.
This applicant begins with a childhood recollection that demonstrates a longing to heal her grandfather. The point is powerful, but it's not meant to sustain the entire discussion. The next paragraph jumps to her interests in science, and by the beginning of the third paragraph, the dichotomy theme becomes clear: "Although science has always fascinated me, it is the interpersonal interaction that primarily draws me to the medical field." The writer allows this point to unfold naturally as she stays grounded in specific experiences, thereby eliminating the need for an early thesis statement like the following: "I want to study medicine because it combines my love of science with my desire to help others." (In case you forgot, this was one of the clichés we identified in the Common Flaws section of the course.)
Later transitions add new dimensions to her overarching theme: "I always imagined that I could learn much from my patients as a doctor. My experiences at Vitas Hospice have confirmed such inclinations and have infinitely increased my love of medicine." The themes culminate in the final two sentences of the essay: "From the time I took my grandfather's seemingly massive arm in my own inexperienced eight-year-old hands, to the day I recently accompanied Mr. C. on his final fishing trip, I have appreciated the dual value of providing comfort to and gaining knowledge from patients. I can now look forward to gaining a greater understanding of the technical aspects of medicine and further cultivating my interpersonal skills to improve my ability to serve." It can be effective to recall the evidence in reiterating the points, as the writer does here.
Whether you choose the Upfront or Gradual approach depends on the overarching themes you choose. If you have a useful comparison to make or any other framework that lends itself to succinct expression, then providing more direction at the beginning can be very helpful. But if your ideas need to be developed before being tied together, then you should let them unfold naturally and save the integration for a nice, forceful ending. Whichever route you choose, make sure your theme is multi-layered and sophisticated. Any oversimplification would not do justice to your candidacy.
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