The Corpus Callosum

New Premedical Curriculum?

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:

href="http://content.nejm.org/cgi/content/full/359/3/221">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once-settled scientific principles have been replaced by more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 “ href="http://content.nejm.org/cgi/content/full/359/3/221/DC1">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.  

Comments

  1. #1 bob koepp
    July 23, 2008

    I tend to agree with your take on these recommendations, especially at the end where “ethics” comes into the picuture. I think it could only benefit everyone involved if “medical ethics” was part of the core pre-med curriculum.

  2. #2 Garrett
    July 23, 2008

    These are some pretty hollow, non-revolutionary recommendations. Most college statistical courses are so procedural that I don’t think most of my colleagues with intro stats classes were any better equipped to read papers than ones who didn’t. Fundamentally, we need undergraduate epidemiology courses that emphasize decision making. And those courses don’t really exist.

    Fundamentally, Harvard’s medical school curriculum depends on Harvard not having to actually teach things that are best taught in a classroom.

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