This is the title of Aaron Carroll’s April 11 blog post over at The Washington Monthly, which coincidentally appears at the same time as a Perspective piece by David Muller in the April 10 issue of The New England Journal of Medicine: “Reforming Premedical Education — Out with the Old, in with the New.” Muller writes that it is time to abandon medicine’s fixation on pre-med’s Four Horsemen: biology, chemistry, organic chemistry, and physics. He continues:
Recent years have seen many calls for enhancing, overhauling, or abolishing the traditional premed requirements. Critics argue that the pace of scientific discovery and its clinical application have outstripped the requirements; that information technology has made memorizing vast amounts of content unnecessary; that the requirements lack clinical, scientific, and social relevance; that they’re used to cull the herd of talented aspiring physicians; that they disadvantage minority and female students; that they crowd out studies of bioethics, social justice, and health policy; and that rigidly structured premedical and medical school curricula hinder students from becoming self-directed lifelong learners. Furthermore, the current model has perpetuated “premed syndrome,” a culture of aggressive competition for grades that conflicts with the precepts of medical professionalism: academic and intellectual rigor, creative thinking, collaboration, and social conscience.
Muller doesn’t say that entering medical students shouldn’t take science courses. For the past 25 years his medical school (Mount Sinai’s Icahn School of Medicine) has run a Humanities and Medicine “early assurance” admissions program for humanities majors. The students must take some “clinically relevant” science courses the summer before their senior year and some basic science the summer before entering medical school, but that’s about it. Oh, and these students don’t have to take the MCAT, either. By most metrics, the humanities do as well as the science majors, and the program is being expanded next year so that half of the entering class can have any major under the sun. There are various other requirements, and the school will provide enhanced guidance and advising functions for these nontraditional students. The payoff, they hope, will be to
dramatically expand the educational, cultural, and socioeconomic diversity of entering classes and our health care workforce. By eliminating MCAT use, outdated requirements, and “premed syndrome,” we aim to select students on the basis of a more holistic review of their accomplishments, seeking those who risk taking academically challenging courses; are more self-directed than traditional medical students; pursue more scientifically, clinically, and socially relevant courses; and pursue independent scholarship.
Who knows how quickly these kinds of changes will be adopted by other medical schools and most especially by the Association of American Medical Colleges? It will be interesting to see if we are at the beginning of a revolution in medical education that will rival that of Abraham Flexner’s revolution a century ago. If we are, SMU will need to radically rethink and revise the way it prepares its pre-meds for medical school and ultimately medical practice.