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News Flash! Pre-meds Don’t Make Better Doctors!

Jay

A recent study in Academic Medicine challenges the conventional notions of what students need to do to prepare for medical school. Mt. Sinai Hospital has a program called HuMed, in which they offer guaranteed med school admission to college undergrads (sophomores and juniors) who are majoring in the humanities or social sciences, and they waive the other requirements – no physics, no organic chemistry, no MCATS.

Turns out the HuMed students do at least as well as the traditional students on every measurement except their scores on the first step of the three-part licensing exam (which, by the by, has been clearly shown not to correlate with anything meaningful in one’s later career in medicine). HuMed students are far more likely to receive an honors grade in their psychiatry rotations, and also more likely to select primary care and psychiatry residences. The only other difference is that they are more likely to take leave for non-educational reasons (which to me says that they are more likely to have rich lives outside school).

I was an English major in college, with a concentration in American Studies. I wrote an undergraduate thesis on the works of Eugene O’Neill. I also took the premed requirements, because I had to, but taking organic chemistry, as usually taught to undergrads, and getting a decent grade doesn’t mean that you actually understand anything. I had to learn everything over again in pharmacology, anyway. I did receive honors in my psych rotation, and I chose a primary care specialty. I read this study and smiled, and felt validated.

And then I saw this:

In an independent comment, John Prescott, MD, chief academic officer of the American Association of Medical Colleges, noted that this program is “unique and shows that you can take highly qualified students and they will succeed in this setting.” He points out, however, that this is not an “either/or” discussion. “We need physicians who can communicate well, who can adapt to change, and display altruism. But we also need physicians with a sound foundation in scientific principles.”

Um, what? It’s not an either/or, but it is? We can either have docs who can communicate with patients and display altruism, OR we can have docs with a sound foundation in science? Huh?

I have had patients ask me where I went to college and what I majored in, but I’ve never had anyone say “Oh, you were an English major? Well, could you go find me a physicist instead, please?” I’m here to tell you that it is entirely possible to be a doctor with good communication skills and a strong scientific fund of knowledge, and if you were the one wearing the stupid gown with the draft in the back, you’d damn well want both.

38 thoughts on News Flash! Pre-meds Don’t Make Better Doctors!

  1. Wow, organic chemistry doesn’t make you a better doctor? Shocker! I didn’t get a single thing out of that class except how to make TNT and a bad grade thanks to a jerk professor. It has not helped one iota in my veterinary career and I think it stands in the way of many people who would be excellent medical professionals. We used to say my school’s requirement for two semesters of it was only to weed out the weak.

  2. Great post/great idea…the focus on GPAs and MCATs and the grade-grubbing and whining and “I don’t want/need to understand, I just need to know what I have to memorize for the test to get an A” makes me (and other colleagues) who have actually taught courses full of pre-meds to keep a list that says “if I ever go to a doctor’s office/hospital and see any of these names, I’m going to make a run for the door.”

    Too bad the idea of a college education as a honest-to-God learning and broadening experience is more valued…learning how to seek out information, evaluate/analyze/synthesize/make connections and comparisons with other knowledge using good critical thinking and communication skills…those things will help in any job and will make one able to be lifelong learner in a fast-paced world.

  3. I think that Dr. Prescott’s comment actually agrees with you, Jay. I read it as saying that doctors need both skill sets, not that you need some doctors with good communication and crappy scientific backgrounds and some with the opposite. To be more precise, maybe he should have moved the “also” and said: “But we need physicians who also have a sound foundation in scientific principles.”

    I don’t think that even those grade-grubbing and rich-life-lacking premeds (lol, srsly?) think that being good communicators and being altruistic are bad characteristics to have in doctors, nor do I imagine they think that good science and good character are mutually exclusive. And I find it very hard to believe that Dr. Prescott thinks that either.

  4. Yeah, Bagelsan, it’s possible that he agrees with me, but I’ve been on the receiving end of that kind of judgment enough to suspect otherwise. I ran the quote by a few other folks before I wrote this and they read it the same way.

    In addition, the article itself posits that the HuMed students are more altruistic and have better communication skills, so by saying “we still need physicians with a strong grounding in science” he is placing them in apposition.

  5. The results of the study are not surprising. The vast majority of medical students will never be medical scientists, and both the skill set and knowledge-base necessary needed to be a good medical scientist are different from those needed to be a good physician. However, it is one thing to say that, e.g. organic chemistry doesn’t really contribute to being a good medical student, and quite another to say that it is an impediment, as Meghan does. There is no evidence that we’d have on the whole a better crop of doctors if we simply abolished the standard pre-med curriculum. Possibly a better intervention than cutting the “harder” science courses like physics and orgo, would be to allow substitutions of those courses for additional courses in statistics, higher level evolutionary or molecular biology, or biological anthropology, all of which might provide knowledge that proves to be more portable. The goal of reform, if we’re into reform, should be to improve performance, if possible – not merely fail to make things worse.

  6. I also didn’t personally read Dr. Prescott’s quotation as delineating a group of physicians who are good communicators versus physicians who have a solid background in the sciences; I interpreted it as saying it’s not enough to be a good communicator. You must also have a solid background in the sciences. Which is true about medical school success, in my experience, but as a practicing physician…I don’t know, I’m not there yet.

    I’m also with JP in that the pre-med requirements should be expanded, or perhaps there could be separate tracks for those looking to do research and those looking to have patient practices. It’s shocking, absolutely shocking, what sometimes comes out of my classmates’ mouths (and probably mine sometimes, too). Some weren’t aware women could (like, were physically able to) give birth in a position other than lithotomy. Some suggested telling IV drug users they were HIV+ would be a good way to “scare them straight”. Organic chemistry is a great tool for those docs who are going to work in labs and do research; those who want to go into practice would be far better served by psych or soc, gender studies, ethnic studies, medical history, bioethics, etc.

  7. Wow. HuMed sounds like a really cool program. As a humanities/non-pre-med science dual major at a school with a lot of pre-meds, it strikes me as quite radical in a good way.

    I’m really enjoying your posts, Jay!

  8. That does not surprise me at all. I’ve worked in a teaching hospital for YEARS. Most MDs will never use organic chemistry in the course of their careers unless they are bench scientists, and maybe not even then. I think it’s more of a rule out course (with the people on top thinking that if one can’t manage to pass it, it keeps the pool of physicians-to-be much lower, thus less competition for those med-school spots).

    You are not the only MD I know who has an English degree. She’s a good physician, too.

  9. As a pre-med, I’m a tad confused. I hope this was just a study, (but which I agree with the results) because to take away meaningless criteria would mean i just took all those sciences for nothing, basically. oh, and that mcat i grueled over. wish i had known about this …3 years ago… i may as well say it, bitterly, at this point it is to me: NOTFAIR. i understand the reasoning, but the mcats are just one arbitrary hoop we’ve had to jump through since the early 20th century. if we have to take these classes in medical school, why not use them as a standard for gaining acceptance into a school which will ultimately be using them anyway? sorry i derailed a bit. i JUST took the mcats. brain=fried.

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  12. Kristen, I hear you. I jumped through all those hoops, too, and it sucked. If you can’t whine the day after the MCATs, well, when can you whine? Have at it.

    But at some point “I did it, even though it was pointless, so you have to do it, too” just stops making sense. There’s a lot of research in the ed literature that shows that grades in a traditional pre-med track and MCAT scores correlate with grades in the first two years of med school and with scores on the MLE step 1, but not with any measures of performance in clinical training (third and fourth years of med school and residency). That has a lot to do with the way science is taught, but it’s true.

    The HuMed program has a summer institute that offers a grounding in science to those students who haven’t taken it, and I suspect they do a better job of teaching the subjects in a way that promotes true understanding.

    What I’d actually like to see is the reform of science teaching so that everyone has access to scientific literacy – the kind of literacy that Kaija is talking about. Meghan is right, unfortunately, about the role that organic chemistry plays in pre-med programs.

    I thought I made it clear in my post that I think docs need a good understanding of the relevant science. I managed to acquire that understanding even though I was an English major, and I don’t think my undergrad science courses helped all that much.

  13. Some of the most prominent examples of students who went through the program in the article not only came from upper/upper-middle class backgrounds, but also had parents who were not only medical doctors, but also med school faculty themselves. The way the article was written can easily lead people to conclude that this HuMed program is in practice, a way for socio-economically privileged and well-connected undergrads to get into medical school by bypassing requirements that their less privileged and connected counterparts must comply with.

    It does not help that IME, there is a stereotype on some campuses and certain circles that most humanities majors are socio-economically privileged undergrads who either are unwilling and/or unable to “work harder” by majoring in a “more rigorous” field such as the natural or technological sciences.

    What do you think?

  14. I would give the program more credit if it promoted acceptance of more disadvantaged/underrepresented students.

  15. exholt, I didn’t see any data in the article I linked to about the HuMed students having med school faculty for parents. I think the admissions process is problematic in many ways, including the institutionalization of privilege. Since MCAT scores can be improved by taking test prep courses, and it’s possible to get higher grades in the basic courses if you can afford to spread out your load over the summers if you don’t have to work, the traditional track rewards the wealthier students as well.

    As far as science being more “rigorous” than the humanities, and the stereotypes about humanities majors…shrug. I’m sure that attitude exists, and I’m not going to change it by remonstrating about the rigor of critical thinking skills in humanities scholarship.

    Privilege exists. It’s instutionalized. I’m not defended that, but I’m also not going to hold one small program at one medical school responsible for it. Med students opt out of primary care because they need a higher-paying specialty to pain their loans. The system is broken. It needs to be fixed. Until then, this program seems to produce docs that we need – primary care docs who have strong communication skills. How is that a bad thing?

  17. Thanks, i didn;t mean to attack your article. It was great. I guess I cannot take issue with this program without taking full issue with the way medical education itself (and healthcare in general) is handled in the US.

  18. It maybe that the majority of those who undertake HuMed are priveleged, but I am doubtful that they are significantly moreso than those who enter medical school; that’s just the nature of the field.

    Where I think Dr. Prescott and many in his position err is the gross overestimation of scientific knowledge needed to practice medicine. Yes, one needs a base level of awareness of some scientific principles, but dynamic use of these on a regular basis is rare. Precious few MDs have the time to keep up with the scientific literature, and it would be unfair to expect them to. And there’s a reason very few MDs go full time into science; the training they receive in medical school is largely inadequate. Most of the science MDs do is clinical, which would be best served with a strong background in statistics. Which is why I agree with EAMD above, most pre-med students would be better served with more courses in the humanities such as sociology, ethnic studies, ie courses that would allow them to be better communicators, rather than with science courses of which very little would be practical.

  19. I am not surprised that highly motivated, bright humanities majors interested in medicine do better in their medical careers than pre-meds who majored in biology because being a physician is the thing to do. I am a faculty member in a chemistry department at a state school, and even in this day and age, a lot of students are just fixated on medicine as a career (perhaps because for many students from less than privileged backgrounds, “physician” is the upper-middle class career with which they are most familiar). And perhaps just as many students really have no choice in the matter as the system expects families to chip in with college educations and many parents are fixated on their kids becoming doctors.

    And yes chemistry courses are predictive of medical success for these students — echoing a comment made above, I have had students that I would not want to provide me with medical care. At the very least, I think it’s really sad that so many kids are forced into the pre-med track by their parents or their own expectations even though they really have no aptitude for medicine (and I don’t just mean that they are doing poorly in my chemistry course 😉 — I mean that they are doing poorly because they can’t think through problems, they don’t observe the world around them and they have no intellectual curiousity; how will someone who can’t reason through what may be wrong with a patient, who lacks the observational skills to assess a patient’s signs and symptoms and who has no curiosity about what makes people tick be a good physician? Of course science courses are not the only way to assess these skills …)

    I think the real question, though, is what do we learn from this study. In a sense, this study is not predictive: if I take Joe or Jane Pre-med and convince them to major in the humanities rather than in biology, I imagine they would not do any better (and perhaps would do worse) in medical school and in a medical career than they would have done as bio/pre-med majors.

    I guess it is late and I am rambling incoherently, but a few thoughts:

    * I did not do as well in organic chem as many “pre-meds”, but after a year or two I remembered more organic chem than they did: what’s the use in taking a course if you’ll memorize it and then forget it.

    * I actually was interested in medicine at one point and took the MCAT. Maybe it’s because I did well on it, but I thought the MCAT was an excellent test to see who would be a good physician (at least a good emergency room/on call physician). Why? Not because of the test’s content (which was actually pretty basic, IMHO) but because of the test’s length (which I understand has since changed): if you could still think about biology after a day of a grueling, stress-filled test, then you have what it takes to be a physician — at least in terms of emergency work or on-call duties.

  20. I’m kind of torn on this. On the one hand: it’s good to hear that they’re giving credence to the critical thinking that is so essential in the humanities – it’s like someone finally realized that Oh! Social science majors DO have brains, and CAN apply them to more technical areas, too!

    I’m also a big proponent of science-based medicine, and understanding the whys behind why things work. While I have no doubt that the organic chemistry crash course and what have you are going to provide a great foundation, I am curious as to whether there are a higher number of defectors to CAM modalities such as homeopathy, which defy the laws of science, in the HuMed crowd. [Unfortunately, not all people with a “Dr.” in front of their name are always practicing actual medicine (I’m thinking of individuals such as Dr. Arafiles down in TX).] Which is not to say non-science majors necessarily buy into the woo, but theoretically with less of a science background, they might be more susceptible to such things.

    Ah, well, musings. Anyway, it’d be interesting to see more studies about where docs end up over time.

  21. exholt and DAS, I agree so much. It seems obvious to me that a program which trains doctors who come from a nontraditional, nonscience background would attract motivated students, regardless of the preparation they’ve had beforehand. i’d be really interested to see how socioeconomics plays into this as well; whether the medical route is more popular with poorer students who don’t have the ‘luxury’ of taking the liberal arts education first (I know that taking either of those in the US is expensive, but I’m not sure of the numbers). Certainly in the UK the debate over tuition fees in higher education has always involved the argument that since lawyers and doctors will earn a lot of money after graduation, paying university tuition fees isn’t a problem, when of course for many students it is (particularly if they don’t study medicine or law!). I wonder if this skews people toward applying for certain courses.

    I get really sick of the whole ‘humanities majors have better communication skills than scientists’ thing, though..

  22. I’m here to tell you that it is entirely possible to be a doctor with good communication skills and a strong scientific fund of knowledge, and if you were the one wearing the stupid gown with the draft in the back, you’d damn well want both.

    YES THIS.

    In my science communication job, we have people with background in both science and performance, and it doesn’t matter where we started; we all continue to improve our scientific knowledge and communication skills on a job. Doctors are not just science communicators, but that’s a large part of your job, and I don’t care what your background is, as long as you can do the job in front of you.

    The idea that knowledge can only be obtained at school, and that once you graduate that’s it for you, is nonsense, in any case. I don’t care if my doctor aquired all her knowledge as an undergraduate or whether she looks it up in her textbook before my appointment, as long as she provided me with the healthcare I need.

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  24. @clare At my state university in the US, tuition is the same across the board whether you are studying humanities or sciences. This is not to ignore the massive amounts of privilege needed to attend any university, but a liberal arts degree is not contingent upon attending a liberal arts college (which will usually be a private school with massive tuition bills).

    I would like to see basic human decency training required for premeds. When I was training as a secondary ed teacher (since left behind), we were required to take a multicultural education class that revealed a lot of people’s hate. Racism, transphobia, misogyny, homophobia were all out in full force in people looking to become teachers. I think a similar class (ideally plural) would at least be revealing of who is entering the medical profession.

  25. I’m here to tell you that it is entirely possible to be a doctor with good communication skills and a strong scientific fund of knowledge, and if you were the one wearing the stupid gown with the draft in the back, you’d damn well want both.

    So, what? No pre-med ever took English or social science classes? Pre-meds come out of college barely able to grunt “F=ma” and “kreb’s cycle” and haven’t the slightest empathy for patients?

    I don’t use organic chemistry on a regular basis in my practice, but at times knowing it and therefore knowing what is and is not plausible can be critical. To give a very simple example, suppose a doctor without any background in chemistry and physics read the infamous Nature paper on “water memory” at face value and conclude that homeopathy was plausible. A person with a background in basic sciences and, ideally, experience in research, is more likely to say, “Wait a minute…that doesn’t make any sense.” and look deeper.

    Which is not to say that a humanities major can’t be a good doctor. They certainly can, but I have doubts about their being able to do so without taking some organic chemistry and physics. If they’re not required for graduation in the humanities, well, what do you think electives are for?

  26. Ultimately, the study this post is based on is pretty weak. There is no attempt to identify whether the primary justification for the program (ie humanities students are more likely to be good at communicating) is true or not. There is no attempt to follow the students past graduation so we have no information about how many of these recent graduates dropped out during the challenging years of residency. Nor do we know what they do after residency, assuming they complete it: Do they enter practice? Do they specialize? How do they perform as independent physicians as compared to their peers? And is evidence from a restrospective observational study really good enough to suggest sweeping changes in policy?

  27. I do share some of Ducky’s worry about whether medical students without a science background would tend to be more open towards “alternative” quackery. The efficacy of many such “treatments” is exposed as at best indistinguishable from placebo simply by considering the lack of any possible mechanism by which they could work. But to see this, one has to be familiar with the very basic science of the sort one would learn in pre-med courses like physics and orgo and would not likely revisit in medical school, which is much more practically oriented.

    This is not to say, of course, that all or even most ex-humanities med students would be susceptible to such errors. Indeed, I think the worry could be easily addressed by requiring non-science med school applicants to have taken courses in epistemology and/or philosophy of science. In fact, those would most likely be beneficial to ordinary pre-meds as well.

  28. It was so interesting to read this after a post I wrote recently on my own blog–far more off-the-cuff and less researched than this, of course–about my recent experiences with physicians during a string of bad health. I’ve found that recently, up to a certain generation, I’ve been split between doctors with little to no people skills but great scientific knowledge; and doctors with great compassion and bedside manner but poor medicine. And I’ve had a hard time getting both in the same doctor.

    I’ll be interested to see how this study progresses. There’s been a lot more focus lately in medical education on the medical humanities, medical sociology, and patient interaction. I think it’s great–those things are all very important, and it’s kind of shocking to think that they haven’t been as emphasized in the past. But part of me kind of wonders what has had to be removed from or shifted around in the traditional medical curriculum to make room for the new focus. I think studies like this might shed a little light on that.

    Incidentally: The university where I work has programs that offer guaranteed admission to medical school for participating undergraduates in any major, although the med-school prerequisites do have to be covered. One of the highest-performing students in the program was an English major who published three novels before starting med school.

  29. a lot of students are just fixated on medicine as a career (perhaps because for many students from less than privileged backgrounds, “physician” is the upper-middle class career with which they are most familiar)

    Actually, one of the most liberating things for me was the realization that enjoying science and health didn’t mean that I had to be a doctor. That there were other careers out there! I sometimes still wish that I had gone to medical school (I find the prestige factor hard to resist), but if I had, I would still be in training and who knows if I’d actually like it? As it is, I have an MPH and have been working for the last 4 years in a job that I really enjoy which is definitely a win.

  30. I graduated from medical school in 1970 (Yes, I’m that old!), and back then at least, the only pre-med requirement was a B.S. or B.A. degree with a limited number of “basic science” hours, with almost any science course meeting the criteria. So you could meet the pre-med requirement by minoring in, say, “zoology,” and then majoring in Humantiies or any other subject that you chose.

    Once I got into medical school, I discovered that medical students were essentailly taught everything they needed to learn starting from “scratch.” NONE of the science courses I had taken for my undergraduate degree had any meaningful relevance. (I definitely agree with everyone above who says that staking organic chemistry was a total waste of time — and a very unenjoyable course, to boot.)

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  32. Sorry I’ve been absent from this thread for so long – ridiculously busy day at work yesterday and Shabbat services last night.

    The study, which is linked at the top of the post, describes the HuMed program. The students participate in science supplementation programs before matriculation, provided by the medical school and thus (I suspect) focused on the material that’s necessary to understand the basic science courses they’re headed for first and second year.

    I agree with Kristen that the entire US medical system – starting iwth education and going on to healthcare delivery – deserves to be criticized and should be overhauled.

    Dreidel is absolutely right about the irrelevance of undergrad science courses, as usually constituted. Science education in the US also needs a complete overhaul. Marking time in two or three years of science courses doesn’t mean you’ve learned science, by which I mean “learned how to ask scientific questions and figure out how to answer them”.

    I also don’t believe that all humanities majors are better communicators than all science majors, and if we want docs who are good communicators we need to attend to the teaching and learning of that skill. If we want docs who are more empathic and understanding, we need to teach that, too, and we need to treat students and trainees with more empathy and understanding as well, because shit rolls downhill.

  33. I was about to say, I don’t think the answer is less science but teaching science *differently*. People are talking about non-pre-med students later having trouble telling real medicine from quackery, but I read some skeptical blogs and I’ve seen the complaint floating around that many physicians buy into altmed to some degree because they weren’t, actually, taught the skillset needed to critically evaluate that sort of thing during their education. I don’t know how true this is, not being a med student or physician myself, but I know I’ve often wished that there would be more courses on the scientific method and common statistical fallacies… possibly in high school. Critically evaluating studies and scientific hypotheses about health is a skill that pretty much everyone needs these days, I think. Science courses that just focus on drumming the facts into people’s heads can leave them with a highly distorted impression of what science actually is.

  34. I love ochem and I don’t care what anyone says lol. If you’re good at organic chemistry that means you’re a badass.

  35. I trained a practice in the UK, where the majority of medical school courses are 5 year undergraduate (with fast tracking courses 4 year courses for those with degrees in other areas and 6 year courses for those wishing to take an additional research degree as a medical undergraduate). Curricula in the UK have been massively overhauled in the last 10 years with reduced emphasis on the basic sciences and increased emphasis on communication skills. There are now less lectures and more small group tutorials.

    Reaction to this is mixed. Some consultants are of the opinion that they learnt most of their basic sciences for the postgraduate membership exams anyway, others are horrified by a lack of basic anatomy in medical students. I think that the new curricula need time to get right, and the balance has not properly been struck.

  36. Love this post! I wish I could get back some of the time I spent memorizing organic chemistry and physics. I remember asking my son’s pediatrician if he ever used the constant for the permittivity of free space as a physician. Argh. I would have done better learning more (any!) anatomy and physiology in pre-med.

  37. Thirty years later, I can still remember the cheers when the pre-med students I knew were finished with organic. That’s all they ever called it, just “organic.” I do know someone who told me, years later, that he never used it again, which completely surprised me.

    But it should not be a surprise to ANYONE that a doctor needs good, empathetic communication skills. This makes perfect sense. I’m sure it’s because I was a journalism major, but I’m a big believer in the power of persuasion and why you need other people to see your point of view, or be persuaded to see things at least partially your way. Check out “27 Powers,” by Chris St. Hilaire, which offers 27 themes used in marketing, politics, courtrooms and media campaigns (places where communication reigns, so to speak). And these powers can be yours –you get real tactics that will make you more persuasive and a better communicator. I’m thinking every med student would find it useful.

  38. I had a ‘friend’ in college who was a physics major tell me she thought that the forced sterilization of women in developing countries was a viable method of population control. And now she’s in med school. Totally terrifying. I feel like I have a civic duty to warn all future patients about her twisted opinions.

    I mean, I have a hard time believing some science class that a 19 year old took is really going to make or break them as a doctor. But I do believe that viewing women as more than incubators for their uterus will.

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