Fixing health care – encouraging students to enter medicine

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Category : Fixing health care

As readers know, I have spent my entire career working with medical students. Most students are wonderful human beings who really do want to help patients. I am not as concerned with the students we attract as with the students who we do not attract.

We (the academic medical community) have placed several huge barriers to entering the profession. Today I will address the premed curriculum. Soon I will address the “basic science” years.

The term “premed student” stimulates thoughts in many college students, most of which are negative. The courses take much time and negatively impact ones ability to receive a liberal education. Many potentially excellent physicians never apply to medical school because they are unwilling to go through this form of torture.

Now some will argue that this hurdle weeds out those students whose commitment to becoming a physician is rather shallow. They assume that these required classes (biology, chemistry, organic and physics) prepare one for the basic sciences of medicine. They also often assume that the study habits needed to do well in these classes transfer well to predicting medical school success.

Perhaps the supporters of the premed curriculum are correct, but I have seen too many students with great promise elect to forgo medical school because of this course work. We all see too many medical students who have not taken a balanced curriculum. We see too many medical students who have not benefited from studying the humanities and philosophy.

What I believe we are losing are many people who might have become great physicians. Why do we have these requirements? Does excellence in organic chemistry predict that someone will become an excellent physician? Do you need that knowledge to learn medicine?

I hope that we can revisit the basic science curriculum (next rant) and at the same time revisit medical school requirements. Clearly physicians need to understand the science of medicine, but I believe that we should encourage courses that will potentially improve the art of medicine. We should expect our students to think critically in all ways, not just with regard to these four science courses. We should better understand how these courses and the entire premed experience chase students away from a medical career. We should understand whether our current structure helps us attract the best future physicians to medicine.

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Comments (13)

I can’t say that my survey level science classes encouraged much in the way of critical thinking about anything. I don’t know why skill at the rote memorization of a body of facts is more important than, say, a rigorous and well-internalized understanding of Bayes’ theorem. Based on my own experience, the former is more important both in medical school admissions and success, but it’s hard to imagine that one could be a good doctor without the latter as well.

Amen. I’ve seen very promising students decide not to pursue medicine because they were told that if they didn’t love organic chemistry, they’d never make it in med school. I finished my liberal arts pursuit before I took the pre-med classes, and am very glad I did. Even so, I hated organic chemistry and struggled to do well. But I have found that I love medicine, and it comes much easier to me. I consider myself one of the lucky ones, who just hasn’t yet given up.

The basic science requirements for admission to medical school–two semesters physics, two semesters general biology, two semesters general chemistry and two semesters organic, and depending on the school, some calculus–are, in my opinion, not too rigorous. Although many students entering medical school are science majors (myself included), it is not necessary.

How can students be expected to tackle the science requirements in medical school if they can’t handle a few semesters of basic science education at the undergraduate level?

Speaking for myself, I was a science major in undergrad but it was a liberal arts and science degree. I took plenty of humanities, studied abroad, and had a whole host of non-science related experiences. Any student that complains of having to take too many science classes is simply not trying hard enough when they schedule their undergraduate courses.

One could take all the science requirements in just over a year–there are post-bacc programs that do this to get into medical school. Undergrad is usually four years long. That’s a lot of space in your schedule left over.

As for good students not entering medical school–say what you want, but realize that it’s still incredibly competitive and there are still far more students who wish to go to med school than are accepted each year.

The medical school admissions process is a big discussion in its own way, but the increasing competition means that it’s not just science courses that are required to get in. You need volunteer work, clinical experience, interesting activities, high MCATs, a high GPA (including a high science GPA, or BCPM–biology, chemistry, physics, math), some research experience, a strong personal statement and the list goes on.

The students entering medical are great students–and that includes doing well in the basic sciences. I don’t see a problem with out system, it gets more competitive every year.

Hmm, speaking as someone who has a chemistry degree, and really didn’t mind organic chemistry that much, I do wish to ask what the insistence in organic chemistry is in being qualified for medicine. I cannot count the number of physicians I’ve spoken to that say “I hated organic chemistry” when they find out that I have my degree in chemistry.

Now, at medical school, I must also say that the skills I polished in organic, and the knowledge I got in the course, are not currently all that useful. Who shall be the brave first school?

While I think some organic chem is necessary to understand medical school biochem, a full year’s worth is probably not required. Someone should create a standardized “Organic chem for pre-meds” course that is only a semester long.

This is absurd. I was a philosophy major in college and took one pre-med class a semester, hardly back-breaking. The premed requirements are a bare minimum to ensure people applying to medical school have a basic understanding of science. The last thing we need now is LESS scientifically inclined physicians. If the thought of years of studying science and pathophysiology is so “horrible” to you, then you shouldn’t be a physician. That is precisely what PA school is for.

You’re talking about people who won’t go into medicine because organic chemistry is “too hard”. If studying ochem for 2 hours a day is so much work, what is a 100 hour-per-week surgery rotation???

Be careful what you wish for. If the undergrads learn critical thinking in all areas, they may decide medical school is not for them, unless they are independently wealthy.

Wouldn’t it be great if ALL students were taught to practice critical thinking! We could sure use a general population who can vote intelligently and not be easily manipulated by media tricks. OK, thank you for allowing me 10 seconds of political rant. Back to the issue at hand. While I agree that I currently retain and apply zero organic chemistry in my daily work, that darn class was what stimulated me to really hone my time-management skills and also my creative learning and memorization skills. Yes, I agree it might be a silly indirect way to do so and there might be better ways to teach these skills, but the study skills and organizational skills I was forced to develop back then for O-Chem made me a lot better at tackling much of the useless rote memorization that I had to do in medical school =) When I lecture med students today, I often share some of these tips on learning, understanding and memorizing that I developed over the years. By the way, I originally started college as a creative writing / journalism major and finished as a psychology major. Many of my colleagues majored in atypical fields such as Art History, Spanish Literature and Dance and they are among the doctors whose medical acumen I respect most today.

Every field has its classes designed to be a hurdle or supposedly teach some necessary skill set. We in business and my wife in law both had these experiences. The real issue is are these necessary.

Some of the comments have focused on organic chem and there is almost a badge of accomplishment associated with completion of this course. We then hear comments about how this is seldom used in day to day medicine.

To be blunt: I find many doctors to be dull. Some of the skill sets regarding memorization have left them without the ability to apply their knowledge. The simple reality is, five years after graduation 50% of what you learn will be obsolete. The other reality is you will see many, many, horses, and very few zebras.

I would much rather have a doctor who struggled with their classes, but can relate to me the patient, than a doctor who graduated at the top of their class, but is unable to make the transition from class study, to the person standing in front of them.

Steve Lucas

Perhaps the problem is that too many schools use certain “required” classes to weed out their freshman classes. I know the college I went to used Chemistry and Accounting as basic weeding classes – and they were always taught bey TAs who were just plain bad teachers. Sorry, but if I’m paying for something, I want a quality experience.

Anyway, if these doctors have had basic science why don’t they understand the first thing about experimental biases and statistical manipulation? It bothers me greatly that so many physicians are so poorly versed in critical analysis of what they read. Just because it is NEJM does not mean it is a good and reliable study! Who funded the study, what outlyers did they throw out, etc. are all critical things to understanding why and what is actually being measured. I have found very, very few doctors who look at their own literature that way.

I believe that medical schools must change the way they assess the abilities of applicants. I would suggest measuring for emotional intelligence.which, imho, the best way to determine success in relating to and understanding patients. Daniel Goleman describes this in his book “Emotional Intelligence”–a must read
The four constructs are
1) self awareness-the ability to read one’s emotions and recognize their impact
2) self management-controlling one’s impulses
3) social awareness-the ability to sense, understand and react to other’s emotions
4) relationship management-the ability to inspire, influence and develop others
These emotional competencies are easily more predictive of one’s success in a medical career than a good grade in organic chemistry.
R. Scott Lake, MD

Speaking as another physician philosophy major named Bob, I didn’t think the science classes were all that hard either, just really boring 3 hour labs I could have done without. I’m really not sure where this myth that you have to be science major to go into medicine comes from. Several of my med school friends had degrees in history, english, economics, etc. Even my current partners consist of 2 psychology, 1 sociology, & 2 biology majors (plus me the philosophy major). I thought my philosophy classes were more helpful for medical school than my chemistry classes.

Wow, I know I’m late to the party, but I just stumbled across this blog while doing some research for my med school application. And as a hospitalist PA who originally completed a Master’s in Physiology, I find “bob”‘s snide comment about becoming a PA ignorant and offensive. The PAs I know LOVE science and pathophys and most have completed other degrees (and not in philosophy). Not loving ochem and physics – which you will NOT use in the day to day treatment of patients – does not mean that you shouldn’t practice medicine. Not to say it shouldn’t be a requirement – it simply shouldn’t be the entire emphasis, which I believe was the original point of this post and ironically enough supports your philosophy degree. And FYI – the majority become PAs because of life circumstances, not because they can’t handle the curriculum or think it’s “horrible”.

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