A new paradigm for pre-meds?

To be admitted to medical school, it has always taken good grades and a strong background in the sciences. Most pre-med students load up on college courses in biology, chemistry, physics and math. Twentieth-century American history or the poetry of Yeats? Not so much.

There’s traditionally been a strong belief that college students pursuing their premedical studies should concentrate on the sciences rather than the humanities, and that this preparation will make them more successful in medical school and ultimately help them become better physicians.

A new study, published in the August edition of the Academic Medicine journal, has come along to punch a few holes into this belief. The title more or less sums it up: “Challenging Traditional Premedical Requirements as Predictors of Success in Medical Schools: The Mount Sinai School of Medicine Humanities and Medicine Program.”

The study involved about 700 medical students at the Mount Sinai School of Medicine in New York. Eighty-five of these students were enrolled in the school’s Humanities and Medicine Program; the rest took traditional coursework. After analyzing and comparing data on academic outcomes for the graduating classes of 2004 through 2009, the authors concluded, “Students without the traditional premedical preparation performed at a level equivalent to their premedical classmates.”

In the interests of full disclosure, I graduated from a liberal arts college where most of my coursework was in the humanities. I’ve been increasingly disturbed at how the sciences are pushed on young people as the ticket to a “good” (read: lucrative) career, the implication being that the humanities don’t hold the same value. So reading about this study in Academic Medicine made my nerdy little English major’s heart skip a few beats.

Among the findings: Students enrolled in Mount Sinai’s Humanities and Medicine Program were just as likely as their peers to graduate from medical school with honors or distinction. Interestingly, they also were more likely to choose residencies in primary care and psychiatry, and less likely to gravitate toward anesthesiology and surgical subspecialties. They did not perform as well on the U.S. Medical Licensing Examination Step 1, which may have been a reflection of their nonscience background or perhaps how the test itself is structured. The study’s authors noted, however, that even with slightly lower test scores, this “seems unlikely to affect their clinical skills or to keep them from securing high-quality residency training positions.”

The Humanities and Medicine Program is intriguing in and of itself. Qualified college sophomores and juniors majoring in the humanities or social sciences who sign up for the program are guaranteed admission to the Mount Sinai School of Medicine. (Lest anyone think it’s easy to get in, it’s not: The selection criteria include high school and college grades, SAT scores, two personal essays, three letters of recommendation and two interviews at Mount Sinai.) Once accepted into the program, HuMed students don’t have to take organic chemistry, physics or calculus, nor do they have to take the MCAT exam. They do have to maintain at least a 3.5 grade point average, however, and they also must earn a B or better in biology and chemistry.

There’s no program like it at any other medical school in the U.S., so it’s hard to know whether the findings from this study can be replicated elsewhere. Nor did the study look at how Mount Sinai’s HuMed graduates fared in clinical practice.

It all raises some interesting questions, though, about how we prepare future physicians here in the United States. Do pre-med students really need to sweat their way through organic chemistry in order to meet the admission criteria for medical school? Do medical schools needlessly skew the application process? Have they tilted too far toward the sciences and away from the humanities, and is this in some way detrimental to producing physicians who are well-rounded human beings?

It’s a somewhat controversial question in academic circles. There’s been little movement, though, to address it more fully, the journal article acknowledges:

Despite general agreement that many premed requirements are of limited educational value for the practicing physician or active scientist and that a broad liberal arts education provides direct benefits to practitioners and their patients, little progress has been made toward a fundamental reappraisal. In 2009, over 80% of matriculating applicants entered medical school with majors other than the humanities or social sciences. The belief that the premed science background (including one year each of organic chemistry, physics, and calculus) is the best form of student preparation for medical school persists, and admissions committees’ reliance on exceptional MCAT scores prevails.

This emphasis on the sciences percolates all the way down to high school and even junior high. Career counselors urge students interested in medicine to start beefing up their science background as soon as possible. It’s thought by many observers that if students wait until their junior or senior year in high school, it’s too late. You can’t help wondering about the long-term impact of this do-or-die channeling of young people’s interests and the academic choices it often forces them to make.

To be a good clinician, unquestionably it takes a strong background in the sciences. Majoring in the sciences does not necessarily turn someone into a soulless robot, just as an emphasis on the humanities doesn’t necessarily guarantee someone will be perceptive and empathetic. It’s worth asking, however, whether a more balanced premedical education would ultimately be better both for doctors and for their patients. This study offers at least some preliminary evidence that it’s possible for medical students to hold their own even when they haven’t spent all their college years in the science lab.

Update, Aug. 11: Here’s a personal perspective on this issue from Dr. Bob Wachter, who majored in political science.

Photo: Wikimedia Commons

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