McKenzie McConaha

Honors 4013

Dr. Pardue

7 November 2011

Are Current Pre-Medicine Standards Enough Preparation For Our Future Doctors?

            “In nothing do men nearly approach the gods than in giving health to men.”  This is a famous quote from Cicero which describes they way in which every doctor wants to be seen.  What is the first step for doctors to reach this god like state?  By knowing all there is to know about medicine and the human body?  What if I could tell you that doctors are being held back by menial restrictions called the pre-medicine program?  My research question (are curren pre-medicine standards enough preparation for our future doctors) addresses all of these previous stated questions and many more.

When medical school first began the only people permitted to attend were the people who could pay for it.  After a while people started to see the obvious need for standards to be set for such an important job.  Thus, the premed program started with a man who was hired to compare what introductory knowledge most medical colleges required.  This man came to the conclusion that a basic knowledge of botany, chemistry, physics and biology was needed for all medical students.  This requirement has not strayed much from this path even in this day.  However, how can a study taken so long ago still be in effect today?

Science and medicine are constantly changing.  A lot of the information in the field of medicine known today was not known ten to twenty years ago.  Therefore, you would think that the understanding of these subjects would need to be expanded.  However, premedical standards are at a standstill.  Classes that were thought to have been important are now being questioned, and knowledge that we now know as important to medicine is not being incorporated into the curricula.  The top example of this is organic chemistry.  Many people agree that knowledge of organic chemistry is important.  However, the extent to which this course is taught is under heated debate.  Dr. Kirch who is chief executive of the Association of American Medical Colleges says “There are far too many people who would be superb doctors who somehow imagine that, because they do not see themselves as organic chemistry experts, they should not pursue medicine as a career.”  This class is thought by many medical students and professionals to be a “weed-out” class and an unnecessary class filled with memorization and repetition.  To remedy the situation biochemistry, which is currently not a required class, should be combined with organic chemistry.  With this you get the understanding of what organic compounds make up the body and how they react.

The second most popular example of an unnecessary class is physics.  Physics is used every day in medicine.  MRIs, CAT scans, ultrasounds, and other medical procedures involve physics immensely.  However, the argument with this subject, as with other subjects, is the extent to which a premedical student needs to know this information.  Is what’s being learned in a basic physics class ever going to be used in a medical setting?  Do you really need to know the velocity of a rock being thrown off a hill to be able to save a heart attack patient?  These classes that are deemed important could be replaced with classes more relevant to the field of medicine.  Classes which are not required such as biochemistry, molecular genetics, and cellular biology could further a student’s knowledge of the body and how it works.  Instead students are required to go through these tedious, complicated and for the most part irrelevant classes.

There are people who believe that medical science should be saved for medical school.  These consist of people who think that there should be less science taught and more humanities, and of other more radical people who think there should be no set curricula at all.  More humanities makes for a more well rounded individual, but there is time to take such classes without cutting down on science courses.  If more relevant science courses are taught during the premedical years it will make time for medical school to teach more advanced medical knowledge thus, making a better doctor.

What is the importance of all of this information?  If meaningless requirements such as organic chemistry were replaced with new more important sciences such as biochemistry or molecular genetics there would be endless possibilities to the changes in medicine.   If our future doctors are taught more relevant information in the beginning of their schooling, so that medical school doesn’t have to spend time on these basic science courses our doctors could be more advanced.  With more advanced knowledge come more advanced discoveries and treatments in the medical world.  We cannot expect our future doctors to be on cutting edge of the medical field if they do not get a cutting edge education.

Summaries

Premed Requirements: The Time for Change is Long Overdue!

            Every year students come to college with wants and dreams of becoming doctors.  However, very few of these students will actually meet their goal.  This is due to the fact that most will not be able to meet their premed requirements.  The students that do might be turned down, because medical schools do not have enough spots and can only allow a few in.

Before the 1900’s there were not a lot of requirements to become a doctor.  In 1904 people started to declare a need for standardized pre-medical requirements.  Therefore, a man was chosen to travel to different medical schools to see what was taught most, and what needed to be learned pre-entry into medical school.  His survey found that an understanding of physics, biology, chemistry and botany were needed for entry into professional schools.  In the 1930’s the requirement for entry into medical school was two years of college with at least two semesters of physics, general chemistry, botany, six hours of English and at least one semester of organic chemistry.  The only requirement for premed that has been change since then is the demand for two semesters of organic chemistry.  There has been a lot of criticism on these requirements since they were put into place.  Premed classes are set to give a broad education before students start medical school.  However, it has been reported that premed requirements are too focused on the sciences and therefore “defeat its purpose of a broad based education”.  The Association of American Medical Colleges even stated that there should be more emphasis on the humanities and less emphasis on science.  Experts say that pre-medicine courses are too hard and provide nothing to the student.  Since students receive a lot of their basic science knowledge in medical school, it is pointless to have them learn it so in depth in college.  Experts say premed requirements should be reexamined and then revise the MCAT to the changes that have been made.

Premed courses are supposed to be used to help the student become more familiar with the science they will learn in medical school.  However, calculus or physics are not really taught in medical school.  Also, there is a belief that organic chemistry should not be taught as in depth, but instead should be combined with biochemistry.  Experts say that organic is just a memorization course with no individual thought put in by the students.  Premed classes are designed to help you do better on the MCAT, but if your classes are not based on what will help you as a doctor, the why is it a requirement?  As stated before, pre-professional classes should be used to help the understanding of introductory science courses in medical school.  However, it is thought that these requirements are made to reduce the number of applicants to medical school, with the number one “weed-out” class being organic chemistry.  Surveys of dropout pre-medicine students showed that the majority of students dropped it because organic chemistry or their grade in organic.

After Criticizing Premedical Education, Are We Missing the Point?: Premedical Education: A History of Critique

            Before a report written in 1910, it was easy to get into medical school if you had enough money.  Money was the only restriction for medical school, if you could pay for it you could go.  After the report brought attention to this, changes were made.  Today the way to get into medical school is through the MCAT, high grades in undergraduate studies and extracurricular activities.             Since this study many arguments have and are being made about the best way to implement premedical education.  There are people who think premedical education should be constantly changing with medicine and science.  There are people who think this education should not focus so heavily on the sciences, so that more room can be made for the arts.  Finally, there are people who think that there shouldn’t be a set education at all.

There are people such as Lewis Thomas who strongly believe that premed education should be done away with.  He believes that any student who claims to be pre-med and nothing else should not be accepted into medical school.  Others believe that premedical education should focus less on the sciences and that the humanities should be important too.  An advocate for this type of thought is a man named Wolf.  He believes that people who make it into medical school only think within the parameters of what they need to know and know little about the humanities and creative thinking.  People who think that premedical education does not keep up with the constant changes in medicine and science include people like Emmanuel.  He believes classes such as organic chemistry, physics and calculus are useless to premedical students.  He states that knowing the velocity of a spinning top, the Diels Alder reaction, or how to calculate sin theta will not help a doctor deal with a cancer patient.  He thinks that premedical education is outdated, and organic chemistry, physics and calculus are only “weed out” classes and should not be required.  If these classes are not required it would give students more time to take relevant classes such as biochemistry and molecular genetics.  Emmanuel has numerous supporters in the medical community.  However, some people believe that the three classes should not be dropped completely.

This Class is Certified Organic: Indigestible, and Perhaps Perishable

            Throughout this article the main topic is whether organic chemistry really needs to be a requirement for medical school.  Most of the experts say that some organic chemistry is needed to understand how carbon combines with itself and other molecules.  This is because carbon is “the building block of life”.  However, most agree that pre-medical students should not be required to study organic chemistry in as much depth as they are doing currently.  There is talk of how organic chemistry should be combined with biochemistry.  If this happened you would have the understanding of carbon bonding plus the knowledge of how that deals with the science of life.

As of now however, organic is being used as a weed out system where students who cannot handle the constant remembering and repeating of organic chemistry will just find another area of study.  Dr. Van Leer states that this is somewhat good because it helps students get ready for the constant memorization and repetition medical school requires.  However, most agree that this can be done with classes that are actually useful to doctors.  It is weird to think that organic chemistry is needed to go to medical school, but biochemistry and genetics are not.  MCAT makers and medical schools are becoming aware of this problem; however, they state this will take a while to change.  Dr. Kirch who is chief executive of the Association of American Medical Colleges says “There are far too many people who would be superb doctors who somehow imagine that, because they do not see themselves as organic chemistry experts, they should not pursue medicine as a career.”

Relevance and Rigor in Premedical Education

            Pre-medical education standards were set a long time ago and have not changed a lot in the present day.  However, how can this be a good thing when medicine and medical knowledge are becoming vaster every day?  Medical school teachers are put under pressure when having to teach fundamental science and medical school level science within the first two years.  Even that is not becoming good enough because medical schools are being pushed to start clinical earlier.  This gives professors less time to teach science that needs to be understood before clinicals.  The current pre-medical standards fail to teach what is necessary for medical school.  There is not enough human and cellular biology taught in premed classes.  Current classes are used more to “weed out” the students who are not serious, but at the same time offer little knowledge needed for professional school.

Also, studies in college and medical school should teach students to think critically.  Students should not only learn sciences such as genetics, biochemistry, etc., they should learn how to combine the subjects and look at the as a whole.  This is because a patient does not have just a genetics or cellular problem; they usually have a combination of all factors.  Around 2006 Harvard started making their classes cross disciplinary.  When they did this they studied pre-medical education to see if it prepared students for this type of learning.  They found that pre-medical classes should be more focused on the analysis and critical thinking of biological courses to better prepare them for medical school.  Colleges have done well by putting some concepts of cellular biology and genetics into introductory science courses.  However, they fail to prepare students in the math and chemistry courses.  Instead of having a full year of organic it should be a semester of introductory organic chemistry and a semester of biochemistry to prepare students for medical school.  Most classes in college should focus on areas relevant to the human body when it comes to all areas of study.  Pre-medical students should also devote time to the humanities, social sciences, arts, etc. to make them well rounded individuals.  This can be done by refocusing pre-medical education around the sciences related to the body and humanities.  The Association of American Medical Colleges has seen the need for such studies and emphasizes that a student should be well rounded.  A medical student should be able to think creatively to solve real world problems like doctors need to do every day.  “Premed should have never become a “trial by fire”.”  Courses will have to change in college and medical school to be able to achieve the above stated readiness, but it is a possible task.  With the changing of courses the MCAT requirements must also change.  However, premedical students will be best equipped with “biologically relevant sciences” for what they will face in medical school.  From there, medical school can teach them what they need to know to be doctors.

From The National Academies:  Medical School Admissions Requirements and Undergraduate Science Education

            Because the field of medicine is constantly changing, the requirements for getting into this field need to be constantly reexamined.  Medical schools expect students to have certain knowledge based on pre-medical requirements; the MCAT tests the students on how well they know this knowledge and medical schools review that.  Science of health is constantly changing.  In a survey by the Association of American Medical Colleges given to medical school teachers in 2001, it was shown that most teachers think organic chemistry is not really important to doctors.  This result differs from a survey given in 1988.  The survey in 2001 also showed a strong need for a biological background which is also different from the 1988 survey.  The MCAT like stated before tests students on the required pre-medicine classes such as organic chemistry, general chemistry and biology.  However, what is important to medical school is constantly changing.  Therefore, if premed is only giving you what you need for the MCAT is that good enough for medical school?  If the MCAT, undergraduate requirements, and medical school do not align then possible consequences will happen in medical educations.  A survey of undergraduate teachers showed that what medical schools say is “important” is being covered very well in premed science classes.  However, not everything undergrad professors find important are also important to medical schools.  Some people think if these ideas cannot align then we will have undergrads just being trained enough to take the MCAT and not well enough to be better well rounded students in medical school.  On the other hand, others think success on the MCAT is closely related to success in medical school.  It is also being shown that Medical students need to be good at other subjects not covered on the MCAT to become better doctors.  Skills such as using evidence to support a conclusion and teamwork should be taught to improve the problem solving skills of a doctor.  However, most professors of pre-medicine feel it is most important to make sure students have facts down and therefore put those other skills on the back burner.  There are also studies shown that minorities do worse on standardized tests.  Therefore, if high emphasis is put on the MCAT, there might be a decline of minority groups in medical school.

Obviously, undergraduate courses, the MCAT and medical school need to align better.  There are steps that are trying to be taken to ensure that alignment will happen.  If undergraduate teachers and medical school teachers could have more communication about what each feel is important to the student, then the three aspects of medical education can align.

Changing Medical School Requirements for Scientific Medicine

            This is a medical student, Mark Hoofnagle’s blog.  He shares his thoughts about the current premed requirements.  Mark is discussing the fact that he was not a “traditional” premed student, because he was a physics major.  He thinks there should not be required pre-medical classes, because the classes now stop students “from being anything but biology majors.”  He quotes an article which talks about having scientific “competency” as a requirement instead of actual science courses.  This scientific competency has to be good enough to help students pass the MCAT.  Consequently, medical schools actually requiring certain biological and scientific classes should not be mandated because there are a lot of different ways you can be competent in an area.  Mark believes that pre-medical classes are ridiculous.  He says that his premed classes helped him somewhat in medical school.  However, the only thing he has retained from organic chemistry is information about solvents and solutes.  The only knowledge used from general chemistry could have been remembered form high school chemistry, and he disagrees about the usefulness of calculus in medical school at all.  Mark goes on to state the only classes that have helped him were the ones that were not required.  Classes that helped his understanding of writing, finding sources and researching were most helpful.  He also thinks that classes that teach you how to think critically and teach yourself would be very beneficial.  There is just too much emphasis on memorizing and repeating in current courses.  This is also what is tested on the MCAT, which he thinks is stupid.  He said because of the way the MCAT is set up the smartest people he knows did the worst and the not so smart people did the best.  Mark goes on to say that’s why he likes the report that talked about competency requirements instead of worthless subjects.

The first two years in medical school they teach you a lot of chemistry and biology.  Therefore, you do not need to spend time in undergraduate school learning these subjects intensely.  College should give you a variety of learning before medical school.  He again bashes organic chemistry, because he ever uses it in medical school.  He wishes that he could have used that time to take classes he would have enjoyed.  Mark expresses his happiness about the reconsideration of premed courses.  There could be a year in college with sciences that get your ready for medical school and the rest of the years used to explore different subjects.  He says what you need to know for medical school is how to evaluate, think critically, and how to be a mature responsible adult.  The last paragraph in his blog talks about his disdain for the current pre-medical program and his strong hatred for the MCAT.

The Importance of Organic Chemistry in Medicine

            Organic chemistry has not always been seen as important for medical or pre-medical science.  Now people are beginning to see organic chemistry’s importance to medicine.  Organic chemistry is being combined with biology to make a close relationship to medicine.  Biologist and chemists are coming together to design a curriculum involving organic chemistry that is more approachable to medical students.

Knowledge of organic chemistry is needed for medicine and biology.  Organic compounds make up all living things.  Life is even said to have began with an organic compound called a nucleotide.  Nucleotides are the building blocks of DNA and therefore are very important to living things.  Organic molecules in the body consist of proteins, carbohydrates, lipids, enzymes, etc.  Without these compounds our body would not be able to function right and we would die.

Medicines are also made form organic compounds.  Doctors must be able to understand what medicines are made of and how they will react before it is prescribed.  Doctors and medical students also need to understand organic processes that occur in the body.  If an organic compound is missing, lacking or too abundant in the body health problems could arise.  Doctors need to have an understanding of this so that they can diagnose problems.  Lots of harmful substances are also composed of organic compounds.  Without the knowledge of these compounds doctors will not be able to treat patients who have been affected.  Organic chemistry is involved throughout the body, in substances that affect the body, and in medicines that treat the body.  Therefore, understanding organic chemistry is very important to anyone in the medical field.

Importance of Physics in the Field of Medicine

            This is a blog explaining the different reasons why physics is important to the field of medicine.  Even though this article was intended to show how physics is related to nursing, it is also useful in seeing how physics is used throughout medicine.  Raymond Lopes states that there is a branch of physics called medical physics.  Medical physics, of course, deals with how physics is used in medicine.  This type of physics has two sub categories, medical imaging and radiotherapy.

Medical imaging is the process of taking pictures of the body with machines for clinical use.  These images help medical professionals figure out medical problems the patient may have and can also help with the treatment recommendations a doctor/nurse may give.  This imaging also helps future medical students see inside the body for learning purposes.  The different examples of medical imaging includes: x-ray, ultrasound, MRI, PET, etc.  There are also different ways physics helps with the treatment of diseases.  This includes procedures such as radiotherapy, defibrillation, lasik, etc.

Finally, procedures such as endoscopy, electrocardiography, and blood pressure measurements are ways of taking measurements inside the body without actually having to physically cut into the body.  Physics is used throughout medicine every day, Lopez states.  Without physics today’s medicine would not be the same.  On the side of this blog Lopez writes, “Physics is very important to nursing because it started EVERYTHING!”.  This sums up his thoughts throughout his article perfectly.

Citations

Dalen James D., Alpert Joseph S. , . “Premed Requirements: The Time for Change Is Long             Overdue!.” American Journal of Medicine. (2009): n. page. 0.

Dienstag Jules M.D., . “Relevance and Rigor in Premedical Education.” New England Journal of Medicine.              (2008).

Goldstein Jacob, . “This Class Is Certified Organic: Indigestible, and Perhaps Perishable.” Wall Street         Journal. (2008).

Gross J.P., Mommaerts C.D., Earl D., De Vries, . “After Criticizing Premedical Education, Are We Missing                 the Point?: Premedical Education: A History of Critique .” Medscape. (2008).

Hoofnagle Mark M.D., . “Changing Medical School Requirements for Scientific    Medicine.”Scienceblogs.com. N.p., 05 June 2009. 0. Web. 07 Nov 2011.

Labov Jay B., . “From the National Academies: Medical School Admissions Requirements and      Undergraduate Science Education.” American Society for Cell Biology. (2011).

Lopez Raymond D., . “Importance of Physics in the Field of Medicine.” blogspot.com. N.p., 23 January   2007. 0. Web. 07 Nov 2011.

McMullin Lynn, . “The Importance of Organic Chemistry in Medicine.” bretoned.com. NSAC, n.d. Web. 07             Nov 2011.