The Corpus Callosum

Harvard Medical School recently completed a review of their required premedical curriculum, culminating with the development of recommended changes.  The outcome of this process is reported in an article in the recent issue of the New England Journal of Medicine.  It's one of their open-access articles:

Relevance and Rigor in Premedical Education
Jules L. Dienstag, M.D.

In recent decades, scientific knowledge has changed dramatically, once-settled scientific principles have been replaced by more sophisticated concepts and entirely new disciplines, and parallel changes have occurred in medical practice and health care delivery. In the face of these new realities, medical school curricula have had to adapt. Yet despite these sweeping changes, including the permeation of most areas of medicine by molecular and cellular biology and genetics, requirements for admission to medical school have remained virtually unchanged for many decades...

Good points: the practice of medicine is changing, medical science is changing, medical school curricula are changing, yet requirements for premedical educations have stayed the same.

To the extent that premedical coursework has changed, it had changed in response to the Medical College Admission Test (MCAT).  This is not mentioned in the article, but it is in the "Supplementary Appendix" PDF.

The committee (HMS Working Group on Admission Requirements) feels that premedical students should spend less time with calculus, but more with statistics.  Agreed.  More statistics coursework would be good.

They think that one year (as opposed to a single course) of expository writing is necessary.  they might be correct.  Certainly, good communication skills are essential.  But some people are good writers and some are not.  Would an extra semester really make that much difference?  Personally, I think that high school is the place for that: more writing throughout.

They think less laboratory time would be appropriate.  I am not sure about that.  Yes, laboratory courses take a lot of time.  Perhaps the information attained per hour is not great. But would cutting down on that (in favor of more lectures) result in an increase in the amount of knowledge attained per year?

They feel that courses should be more interdisciplinary in nature.  Agreed.  Their idea is that such classes could be more focused on the things that are pertinent to medicine, while cutting out some of the irrelevant stuff.  For example, the organic chemistry courses tend to include things about industrial processes, which are kind of neat, but not terribly useful for doctors.

Ideally, instead of devoting time to a second semester of organic synthesis, college students could take a seamless sequence of preparatory organic chemistry and basic principles of biochemistry (especially protein structure and function), completing the study of introductory biochemistry before medical school and building a foundation for medical school courses that begin from and reach higher plateaus.

The main thrust of their argument for change is that they think students need better preparation in genetics and molecular biology.  This is where I object.  

Oddly, the article includes this statement:

To fulfill expectations for more advanced premedical science preparation, college science courses ought to foster scholastic rigor, analytic thinking, quantitative assessment, and analysis of complex systems in human biology; their goal should be to help students acquire a different, larger, more molecularly oriented and scientifically sophisticated knowledge base than that mastered by previous generations of premedical students.

Clearly they have a different idea about complex systems than I do.  To my way of thinking, complex systems are families, communities, cultures, societies, and international relations.  So I when I think complex, I think of things bigger.  When they think complex, they think of things smaller, "molecularly oriented."

Toward the end, the author states:

In recent years, calls have come from various quarters for medical schools to require and for colleges to teach ethics, altruism, compassion, listening skills, and skills relevant to health policy and economics -- at the expense of science requirements. In my view, these aspects of medicine are best reserved for medical schools, where they can be taught in the meaningful context of interactions with patients.

Perhaps.  I know that some medical schools do make an effort to teach these things, but in my (albeit limited) experience, they are merely token efforts.  Plus, skills such as those require years of thought and practice.  Wouldn't it be better to start earlier?  

The committee did agree that "Courses in literature, languages, the arts, humanities, and the social sciences (e.g., psychology, sociology, anthropology, and ethics) are encouraged. At least 16 hours should be completed in these areas."   Rather than teach these things in course "at the expense of science requirements," put them in the humanities, at the undergraduate level.  Then, reinforce them in medical school.