Science has an editorial today discussing a topic near and dear to me, what medical schools should require from undergraduates before admission.
Since I was a bit non-traditional as an undergraduate premed (I was a physics major), I am happy to see that they’ve ignored calls to overload undergraduate education with a bunch of pre-professional courses that prevent people from being anything but biology majors.
How should preparation for medical study be assessed? Medical schools generally determine scientific readiness for admission by course requirements and scores on the MCAT, which mainly reflects the traditional content of those courses. In contrast, medical schools have long evaluated readiness for medical practice in terms of competency–specific learned abilities that can be put into practice–rather than by mandating standard courses and curricula for all medical schools. The report recommends that scientific readiness for medical school entry be assessed similarly: The current list of required premedical school courses should be replaced with required science competencies. Instead of a nationwide requirement that premedical undergraduates take specific chemistry classes, for example, a required competency might be described as being “able to apply knowledge of the chemistry of carbon compounds to biochemical reactions.” The report suggests competencies for premedical and medical school science education, recognizing that there may be multiple routes to gaining a competency. An integrated approach to both undergraduate and medical education may help both to innovate.
The editorial discusses this report from the American Association of Medical Colleges and the Howard Hughes Medical Institute that suggests what should medical students arrive at medical school knowing. For years, I’ve thought the premedical requirements were absurd. You are required to have a year of physics, a year of calculus, a year of organic and a year of inorganic/analytic chemistry (at least when I went through). While I benefited from having a basic science background before arriving at medical school, I have to say, the only things I’ve retained from organic chemistry class of any importance are that like dissolves like, and hot solvent is great for cleaning. I still can not think of anything valuable I learned from inorganic chemistry that I didn’t get in high school like computing basic stoichiometry or making solutions. Physics? Maybe it was more useful (and for me it was interesting in fun), but mostly as a course of study in rigorous scientific thinking, statistics, error analysis, etc. Calculus? Totally worthless for medicine. Even the biology courses tend to be exceedingly general (which I think is good). You know what’s been most useful? Knowing how to write. Knowing how to research for a paper, whether it’s on history or quantum mechanics. Knowing how to think and teach yourself about subjects rather than just memorize them. That’s what college should do, and that’s what medical schools should select for, rather than those who memorized the most facts in premed science requirements. And the MCAT? Don’t get me started. The smartest people I know did the worst on that test, and some of the most useless do well, because it doesn’t test reasoning or anything useful, just memorization of all that worthless junk in all those premed classes.
The report acknowledges this, and emphasizes a different skill set and set of “competencies” for premed requirements, rather than some rote knowledge on subjects you’ll never use again in your life. This made my heart swell and brought a tear to my eye.
The fact is, the first year of medical school is a great deal of catch-up for many students, even chemistry and biology majors, because the majority of what we learn in college is irrelevant to medicine, and that’s a good thing. College should not be treated as a pre-professional school that merely exists to give you specific knowledge to get you ready to be a doctor. There is great value in young people coming to medical school with a diversity of experiences and knowledge. If you like chemistry? Great! By all means, take 3 years of organic chemistry if that’s what you like, but we shouldn’t pretend it will ever be used again for medical school. I’m still angry about the hours of life I wasted in organic chemistry class, never to be used again, when I could have been learning about something I really cared about, or exploring more of the liberal arts classes at my university.
This is why it’s good that experts in medical school have begun to acknowledge that premed requirements do nothing useful to prepare one for medical school, but only really serve as a barrier to the unmotivated by virtue of being a giant pain in the ass. One could easily imagine a 1 year, or 1 semester course containing all the basic science required for medical school (which should be administered pass/fail). It’s more important that people arrive at medical school knowing how to think, knowing how to evaluate the scientific literature, having knowledge of the world and hopefully having a higher level of maturity. The physiology, pharmacology, anatomy – all of it is available in the basic science years of medical school. There is very little specific knowledge one needs at the start.
I’m glad to see there is talk of finally breaking from the stodgy and pointless premed requirements that generations of medical student hopefuls have had to suffer through (despite some, like Jules Dienstag, defending the premed torture as a “necessary gauntlet”. Let’s just hope they implement some of these changes, save premeds years of excessive study of irrelevant subjects, and maybe, if we’re lucky, burn the MCAT for the useless test that it is.