BACKGROUND Although essay questions are used in the admissions process in many medical schools, there has been little research on how applicants respond to essay questions. OBJECTIVE The purpose of this study was to explore how applicants to medical school approach essay questions used in the selection process. METHODS Qualitative analysis was conducted on 240 randomly selected essays written by individuals applying to a single Canadian medical school in 2007 using a modified grounded theory approach to develop a conceptual framework which was checked in interviews with applicants. RESULTS Three core variables were identified: "balancing service and reward," "anticipating the physician role," and "readiness." We described the overall approach of applicants as "taking stock," writing about their journeys to the selection process, their experiences of the process itself, and about their anticipated future in medicine. CONCLUSIONS Our findings suggest a disconnect between the approach of the applicants (to "show themselves" and be selected as individuals) and the stated intent of the process (to select applicants based on "objective" criteria). Our findings raise important questions about how applicants represent themselves when applying for medical school and suggest that it is important to understand the applicant's point of view when developing questions for selection processes.