I just tweeted a NY Times article about letting excellent liberal arts students attend med school with only biology and chemistry (no organic or physics). The program appears to be a great success.
Different physician specialties need different skills and knowledge. While I understand the potential application of organic and physics. I also know that I can be an excellent internist, family physician, psychiatrist, pediatrician, obstetrician, etc without that knowledge. I rarely use that knowledge in any meaningful way.
Might a liberal arts education help physicians in different ways. Might this successful experiment allow some who would eschew med school to become great physicians. Many would argue that a liberal arts education helps one understand people. Is there not value in that skill? Might a traditional premed education detract from liberal arts studies.
I am arguing for a different type of diversity in med school – educational diversity. My experience with students who have a liberal arts undergraduate education is most positive. This program allows them to take the two relevant sciences and avoid the unnecessary hurdles. Med school has enough hurdles.
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Agreed. Except that there should be a mixed "premed" chemistry and physics class since there are fields in medicine that you need some physics knowledge (rad onc/radiology) that would be hard to pick up for the first time in residency. Especially since most 1st year chemistry and physics is useless for medicine. Come to think of it, there should just be a premed physics/chemistry/biology since most of biology is also useless when looking at strict usefulness to medicine. Instead, substitute some epidemiology or classes on how to interpret articles, which is much more applicable to medicine that should just start in medical school.
Very little of what I learned in my Premed classes was directly applicable to what I needed to learn in Med school. There is something to be said for a foundation in the scientific method however, which has been useful in staying abreast of the changes that have occured in medical knowledge since I graduated 30 years ago. A survey course in chemistry or biology cannot provide that mindset. Grounding in the sciences (facts) helps in figuring out what is actually known — something I have to grapple with when I recommend treatments for my patients. My liberal arts education may have made me more well rounded (a good thing) but sadly, it was not the part of my education that made me think critically.
What I found about Organic Chemistry was that it was a very good marker for whether one was able to handle the quantity and type of learning that occurs in Med school. If you can't cut Organic, you will drown in Basic Sciences. The information just comes too fast. And then comes clinical training. As I heard a new intern say earlier this week, "I thought residency was going to be easier than this"
I want my collegues, and more importantly those who will be caring for me now that I am not quite so young, to be smart and well rounded. I want them to have had a rigorous intellectual education. Unfortunately, very few nonscience programs qualify in our current institutions of "higher learning"
Sorry to rain on the parade.
Liberal arts majors in med school? GREAT IDEA.
Likely to happen in significant numbers? NOT VERY
They were talking about this when Dr. Centor and I were in medical school, they were talking about it for a generation before that, that I'm aware of. You know what has happened in that time?
medical students are less well-rounded, less well read out of medicine than ever before (anecdotal? of course. could you trot out an exception or two ? of course. But look at any medical journal today, not only is most of the stuff poorly written, it contains virtually none of the nonmedical allusions common years ago. Where are the Oslers? Where are the William Beans? Compare any major journal today to 50 years ago- better scientifically, much worse in terms of broad reading experience. Which is basically my experience on rounds -the students may be smart, but well-rounded? Not much. ask a student who Osler is next week. And I'm by no means convinced they are better doctors for no tknowing.
Two points- first – IT"S NOT THEIR FAULT. The reason I'm confident it won't change is the institutional torpor and the thinking of those who admit them. Articles like the one in the Times surface every couple of years and the high-ups in medicine basically ignore them. Because so few of them are well rounded in the humanities. You're going to hear that same old argument "do you want a surgeon who is good at operating or one who can recite Shakespeare". Such claptrap- ask that guy if he knows anything about Harvey Cushing.
Second- Classic pre-med training has virtually nothing to do with medical learning anymore. You mean to tell me you couldn't put in a month of organic chemistry into the medical school curriculum and do just fine with what you have to know? Everyone reading this blog knows organic chemistry is nothing more than a winnowing course in undergraduate. It is in many ways inimical to learning. The previous commentator says "if you can't cut organic you will drown in basic sciences" He is correct but SO WHAT????? Neither of them are really helpful to the thinking and problem solving you have to do in practice. The best doctors are those who understand ambiguity, uncertainty and decision making, who can learn new concepts and understand history. virtually the opposite of organic chemistry and most, not all, basic sciences.
And by the way- the same goes for most of the first two years of medical school. Half the time you're teaching junior and senior medical students to unlearn most of the junk they learned in the first two years.
There will more more articles on the humanities in medical school and more liberal arts majors needed – and the situation will remain pretty much the same or get worse in the next generation. We'll load up on trainees who forego broad learning. That's my bet.
“…most first year chemistry and physics is useless for medicine.”???
Only if you have Dr. Centor around to figure out all of your acid/base and blood gas problems.
If you want to, you know, really understand what is going on rather than ask the ward clerk to print out the “Acidosis Protocol,” you damn well better take and remember your basic hard sciences.
“Most of biology is also useless when looking at strict usefulness to medicine.”
Where to begin?
Of course, biology is a rather large topic, so “most” of it is not relevant, but really do you want your physician to be one who is ignorant of “most of biology”, even if she can recite the Divine Comedy by heart?
Much of the strict factual information that we learn in med school is out of date at some point in our subsequent careers, but how are we to understand these changes without a fundamental understanding of biology?
Organic chemistry?
It’s more than a culling process,
although I agree that if a student can’t do well there, she will be lost in basic science in med school. Learning all those equations was an exercise in memorization, but while doing that memorizing we all learned how carbon based life works.
We are just beginning to understand, for example, how statins act in ways unrelated to their “intended” action on lipids, but will we be able to more fully understand if we don’t have an appreciation for the ways that organic chemicals work?
Cory, Drs. Osler and Bean are dead, and so is the profession that they practiced.
The knowledge base that they possessed is a small fraction of what we need to be competent today.
We can romanticize our glorious professional ancestors, but do you think they believed that poetry was more important to the practicing physician than scientific inquiry?
I serve on the admissions committee of a medical school. We get all kinds of applicants- physics majors, English majors, musicians, customary pre-meds, you name it. All get a fair shot at earning admission. We are forced to look at grades segregated by sciences and non-science.
Why?
Because grading in liberal arts classes is, well, liberal. There are no fixed standards in the humanities- typically, any side of an argument can be advanced so long as it is well argued. We want that type of thinking at the cutting edge of medicine, but before any premed gets there, she has 7 or more years of training to do. You don’t want the medicine resident on night float getting too creative at 3 a.m. when the new heart failure patient is admitted.
We don’t give an automatic admit to the hard core science major with good numbers but no sign of human contact, either, but we do look for a minimal scientific competence.
In thinking about this, I believe that basic scientific competence is what separates physicians from the “extenders.” This is no knock on the PAs and NPs out there- they are the ones who have the extra time to read the liberal arts subjects. When you are really sick , you need a medical scientist.
JB:
Thanks for proving my point.
Your post is exactly why it won't change.
I'm not going into a point by point refutation, wouldn't do any good.
But I'll point out a couple of things – acid base happens to be my specialty. I say with great confidence the students and residents know less about it today than they did 20 years ago. How's that science curriculum working out for you?
You said one thing which is really disheartening- Bean and Osler are dead and so is the profession they practiced. No it's not. That's the point. IT's the same profession. Always was, always will be. Arrogance to think otherwise. They were just as smart, smarter in fact than today's million dollar faculty and private practitioners. And they knew about people, way more than most of todays "immortals".
I could make an argument that with portable brains you have to know fewer facts than they did. The brains free you up to think. Isn't happening. Those guys, Bean, Osler, Cushing were the top of the profession then and they would be today. Bet on it. You don't get it, they didn't believe poetry was more important than scientific inquiry- they believed it was essential to understanding scientific inquiry. HUGE DIFFERENCE.
And it is – a lot more than this evidence based medicine fad, which appears to be retarding thinking and critical review of the literature.
Nobody can tell me that the intern who is taking care of heart failure at 3AM is better off because he took organic chemistry seven years before that and got a 94 on the Final. I've never noticed that to be true. Maybe I haven't been watching the right residents.
I can tell we are not going to agree on this JB.
But I do know one thing for certain- you will win the argument. you have been for decades.
READ CAREFULLY: at bottom of NYT story, SATs of students involved was 90th/95th percentile. Not art majors — top of class. Very big difference that NYT should have pointed out and made more clearly.