Changing Premed Requirements and the Medical Curriculum
Ezekiel J. Emanuel, MD, PhD
JAMA. 2006;296:1128-1131.
Changing Premed Requirements
By issuing admission requirements, medical schools have a profound
impact on what thousands of college students learn and do not learn
each year.3 Many premed requirements are irrelevant to future medical
education and practice.3, 16 Does knowing how to integrate sin have
anything to do with caring for a patient or elucidating the role of
TERC in aplastic anemia? Do any physicians, even researchers, have to
know about Diels-Alder adducts? Is calculating the angular momentum
of a spinning top relevant to any medical practice? Most of what is
contained in 1 year of college calculus, organic chemistry, and
physics is irrelevant to medical practitioners, researchers, and
administrators. Researchers who need such information do not rely on
their college courses.
Why are calculus, organic chemistry, and physics still premed
requirements? Mainly to "weed out" students. Surely, it would be
better to require challenging courses on topics germane to medical
practice, research, or administration to assess the quality of
prospective medical students, rather than irrelevant material.3
At least 6 relevant topics are not premed requirements. First, the
mathematics most medical students need are statistics. Statistics are
essential to reading the medical literature, designing research
studies, and implementing quality improvement initiatives. Moreover,
knowledge of statistics is more valuable for life and for being a
thoughtful, informed citizen.
Genetics, molecular biology, and biochemistry are much more essential
to medicine than organic chemistry and physics. True, some knowledge
of nomenclature and organic structures and reactions is important for
biochemistry, but the necessary material could be taught in a few
weeks, rather than requiring an entire year of irrelevant synthetic
pathways. Two courses encompassing genetics and molecular biology
would be much more educationally valuable for medical students than
one in physics.
As the mere existence of the Hippocratic oath attests, ethical
challenges are inherent in medical practice and research.17 Yet there
is no premed ethics requirement. Students need the ability to
distinguish ethical issues from communications, economic issues, or
aesthetic issues, to make ethical arguments, and to give ethical
reasons that justify their decisions. Requiring a general ethics
course is preferable to a focused bioethics course, which should wait
until students have experience with actual patients and clinical
dilemmas.
Moreover, much of the practice of medicine, as well as dealing with a
research team and administering organizations, entails dealing with
people and, therefore, human psychology. Requiring that students take
a psychology course that provides education about established notions
of human behavior, such as the fundamental attribution error,
hindsight bias, transference, and moral distancing, could enhance
physicians' interactions with patients, colleagues, and employees,
not to mention their own families.
Discontinuing the requirements for calculus, organic chemistry, and
physics would open up 6 semesters for more relevant courses. Adding 1
semester each of statistics, ethics, psychology, genetics, and
molecular biology and 1 year of biochemistry, would require 1
semester less of course work if genetics and molecular biology
satisfied the biology requirement. With this extra time, students
could pursue other interests in this formative period, ensuring they
received a true liberal education.
--
Dennis E. Krause
Assoc. Prof. of Physics, Dept. Chair
Department of Physics
Crawfordsville, IN 47933
Office: Goodrich 313
Phone: (765) 361-6181
Fax: (765) 361-6340 http://persweb.wabash.edu/facstaff/kraused/