Current Pre-Medical Education System Unnecessarily Long and Difficult?

[Law2Doc]

The pre-meds complaining about how "useless" their undergraduate education might do well to realize that you get out what you put in. You will have plenty of time to do medicine later, but will never get to take Afro-Carribean Studies ever again.

I would also suggest that these same premeds will still be complaining once in med school about how useless the basic science years are, the rotations not in their desired field of specialty and so on. But anyone in construction can tell you about the importance of having a good foundation before you build upward. This is a career where you will be constantly learning, and not all that learning is going to be applicable to your ultimate job tasks. Get used to it.

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[Chuckwalla]

it is pointless if all you are in it for is the money. its not pointless and important if you are in it to help people. i know you don't need to have a BS/BA to be empathetic to your patient. but to think that all there is to medicine is the technology and science brings medicine back fifty years. you want to be able to learn from your patient and their family in order to help them. if you have a more balanced background, and have lived a little, i think you will be better equipped to help your patient.

Ok, I know it is great to be all idealistic but come on. Taking on massive debt for a degree a med school doesn't care about requires is just stupid. They care you take those prereq classes. Those other 100 or so hours they don't care what classes you took. That is complete proof that it is a waste.

You want to get doctors in poor areas? Get rid of the massive pointless financial hurdle.

 

[Tired]

Ok, I know it is great to be all idealistic but come on. Taking on massive debt for a degree a med school doesn't care about requires is just stupid. They care you take those prereq classes. Those other 100 or so hours they don't care what classes you took. That is complete proof that it is a waste.

Don't Drink & Type kids.

 

[LizzyM]

Ok, I know it is great to be all idealistic but come on. Taking on massive debt for a degree a med school doesn't care about requires is just stupid. They care you take those prereq classes. Those other 100 or so hours they don't care what classes you took. That is complete proof that it is a waste.

You want to get doctors in poor areas? Get rid of the massive pointless financial hurdle.

Or loosen the practice restrictions on physician extenders.

 

[diggitybop]

Ok, I know it is great to be all idealistic but come on. Taking on massive debt for a degree a med school doesn't care about requires is just stupid. They care you take those prereq classes. Those other 100 or so hours they don't care what classes you took. That is complete proof that it is a waste.

You want to get doctors in poor areas? Get rid of the massive pointless financial hurdle.

who said anything about taking on a massive debt as an undergrad? i agree many undergrad tuitions are carzy/messed up/outrageous buts thats a choice you make when you decide where you want to go to college. i didn't grow up with a lot o' money and i knew i would go to a state school. while there i did an interdisciplinary honors program and took as many of these "pointless" courses i could fit into my schedule, and graduated with 0 debt. so for those of you bringing money into the equation that was your choice. granted there are a lot of things packaged into a private name which may be worth the price and the enticement but it is still a choice. as far as adcoms not caring about whether you take these courses, and removing the financial hurdle as incentive to practice in a poor community: i don't know really how to respond because i don't think there is a chance ffor us to see eye to eye on this. i don't agree that adcoms only care about prereqs but even if that was the case is that really the only reason why you would learn something? as far as practigin in a poor community, if the four year requirement was removed, and you practiced straight out of medical school without ever maturing or having looked at things in different perspectives, whose to say that you will be of any use in a community you know nothing about. whatever, i can't believe i'm on this on a friday night. good night y'all.

 

[albaniandoc]

Now, why should pre-meds pay the consequences for a poor high school system?

It is ridiculous. I graduated from a foreign high school and when I did a placement test I just skipped a few math classes. Why would I have to pay consequences for a education system that is faulty. I am sure kids that come from private high schools feel the same way. Maybe there should be a placement test for pre-meds to give them direction on what subjects they need to focus on.

I honestly think that a system like our pharmacy programs is adequate. I don't see a huge number of pharmacists that are lacking people skills because they don't have a bachelor degree. For every rude pharmacist I can point about 10 physicians.

LizzyM, I always appreciate your input but in this case I am going to respectfully disagree. Most RNs do not have a BSN simply because it is more school for same pay. I think (and don't quote me on that) something like 10-15% of all nurses have a bachelor degree. I know in my department I am the only one who does.

 

[rickthetwinkie]

I think if that's your attitude towards non-science related courses in college, you are missing out. I think you can learn things which will be useful to you in just about any class you take. The thought processes involved in reading Chaucer are different from studying orgo, and I think that's a good thing. I may have some bias, since the only science classes I took in college were the bare minimum med school prereqs (I didn't decide I wanted to go to med school until I was a junior). Now, however, I am so glad that I took so many different classes in the process of trying to figure out what I wanted to do with my life. I think it's part of being an educated person. When do you ever get the chance again to study something just for the sake of it?

I will tell you something else - in all of my med school interviews, and even residency interviews, the interviewers were a lot more interested in the fact that I sing opera than in my biology classes. For some reason, med schools seem to seek out that kind of diversity in their classes (which is a little ironic, since it's not like I have done a lot of singing in med school). For whatever it's worth, having some skills that differ from the typical pre-med make you a more interesting applicant.

Another skill that you get in a lot of non-science classes is writing, which is quite valuable in medicine when you are trying to get things published, especially as there are a lot of bad writers around. It's also an essential skill in communicating in the chart, in correspondence to other doctors, etc.

Finally, I agree that the time it takes to finish medical training is a little out of control, but I think some of this is on the back end. For example, I'm in cardiology - should it really take 3 years of internal medicine, 3 years of cards, and possibly even more time to do interventional, EP, etc.? What about doing, say 2 years of IM and 3 years of cards, or 2 of cards and 2 of interventional, or some other combination? A lot of people know when they start IM that they want to do a subspecialty, and, realistically, most people these days don't continue to practice general internal medicine to any significant degree while doing that subspecialty.

Another year which could probably be cut is the fourth year of medical school. Granted, it was a great year, but it's probably not that useful in the grand scheme of things.

I could never have said it better myself. I, too, pretty much stuck to just the pre-reqs and didn't go much beyond them, but I don't regret it. In my opinion, there's an inherent value to the broad spectrum of learning one gains in college.

Speaking idealistically, learning about art, literature, history, and philosophy gives us more connections to humanity and, perhaps, a little bit more understanding. I think it's a little sad that a lot of us(including myself ) forget much of what we learn because these things help us to understand the humanistic side of medicine(hell, pretty much everything). After all, medicine isn't just the science involved. And we don't get a chance to enrich ourselves in this way again because in med school we are finally tracked into a certain type of knowledge and finally introduced to the daily grind. Sure, there are the(sometimes questionable) classes on the "mushy" side of medicine, but it most likely isn't the same or as foundational as, say, the first time I read The Odyssey.

I would argue that without all of this education, there stands the probability of medicine becoming too mechanistic.

Of course, I'm biased, too, because I like to think I gleaned as much from my education as I possibly could. And it probably has a lot to do with your general attitude on learning whether these "hoops" we have to jump through really are useful or not.

 

[TPROrgoTutor2]

Alright, here is my take on the whole schpeal.

College is very important. In regards to what you learn, you are exposed to a great variety of subjects that really help you to be a more well rounded person. I much prefer knowing what I do now in regards to history, art, philosophy, sports, women =), psychology, and so forth than just the core sciences. I think it really helps the person be more functional in society. It feels good knowing that almost any topic that comes up you can have worthwhile input to, in nearly all subjects (except current politics for me, I am downright ignorant in that regard though I'm attempting to remedy that).

Its not really what the classes that are important, though. It helps you grow. When I started I was a completely different individual than I am now in nearly every way. I went from a relative introvert to an extremely social person.I now respect others much more than I did. You can easily tell people who have been college educated to those who have not just in their general demeanor a lot of times. I think that undergrad probably provides the most growth and if you take away that undergrad and replace it with a year or two of core sciences without the "fluff" classes (everything else) you are forcing the people to be around only a select group of peers and not be exposed to the diversity that is undergrad. Everyone is in undergrad from the coke-heads to nerds, each of which contribute a bit to your understanding of people and respect for differences. As hokey as it may sound, this is terribly important.

 

[dutchman]

Or loosen the practice restrictions on physician extenders.

At the risk of conceding to the notion that the length and cost of physician training is excessive, ie, medstudents are getting jacked.

 

[LizzyM]

LizzyM, I always appreciate your input but in this case I am going to respectfully disagree. Most RNs do not have a BSN simply because it is more school for same pay. I think (and don't quote me on that) something like 10-15% of all nurses have a bachelor degree. I know in my department I am the only one who does.

According to a federal survey, in 2000, nearly half of all nurses have a BSN or Masters/PhD. The proportion of nurses with diplomas and associate degrees is holding steady and the growth in the population of registered nurses is in holders of degrees. For at least 10 years it has been the position of the leadership of the nursing profession that the BSN should be the minumum preparation for a career in nursing. Consequently, the "business" of RN to BSN programs is booming.

So, while some of you are trying to push medicine back to the nineteenth century, nursing is pushing forward to produce even more highly educated professionals.

 

[Critical Mass]

Unnecessarily difficult? Not in my opinion. If you can't memorize organic chem, then you probably can't memorize med school material even if both are based on novel lexicons.

Unnecessarily long? Maybe a little bit. I would like to see some basic clinical skills and rudimentary patient interaction incorporated into premedical programs just to bypass a lot of preclinical fluff in med school. I also think that the M1/2 years are over-priced for didactic material.

My main problem with premedical studies is that even though much time and money are spent on college, there still isn't enough exposure required to allow students to learn whether medicine is right for them or not.

 

[Law2Doc]

I would argue that without all of this education, there stands the probability of medicine becoming too mechanistic.

This is exactly the thing the Flexner approach, and the subsequent changes to med school admissions a few decades back (leading to admission of non-sci majors and more nontrads, and instituting a greater emphasis on well roundedness) was designed to address. The prior generations of bio major/premed, by-the-numbers admittees to trade school like tracks was determined not to generate the kind of doctors the profession or patients wanted. So the system was fixed, and more value started getting placed on other stuff. It may not be everyone's opinion of the ideal, but it addressed something that was felt to be lacking of the prior breed. LizzyM is right that some folks on here are bemoaning that medicine is no longer the same as it was in yesteryear. But "nostalgia isn't what it used to be", and there was a lot that didn't work in that old system.

The prereqs are important as hurdles, to guage abilities in science courses, but for the most part do not "prepare" you for med school or to become a doctor. College and experience prepares you on this journey. Get the most out of it, and use it to grow, try new things, and maybe even decide if medicine is really for you.

 

[VoiceofReason]

I'd just like to chime in and say that each time I go to child development and have to hear about Freud, or each time I go to philosophy and have to hear about Plato and his "Forms", I think to myself:

Why the christ am I here? I hate being forced to learn stuff for the sake of making me more well rounded. I don't need it, it doesn't help me in the slightest. I actually like philosophy overall, but plato is repeated ad nauseum in pretty much any philosophy curriculum.

 

[8744]

With absolutely no apologies or caveats to sooth the ruffled feathers of the many PAs, NPs, and other mid-levels who lurk on this forum waiting for a chance to insert their propaganda, once you get to the resident level you will see the huge difference in your knowledge and abilities compared to theirs which is strictly because your education is so rigorous and demanding while theirs is not.

My only objection to medical training as it is structured today is not getting sleep on call and the truly crappy pay we are forced to accept. Getting an undergraduate degree as a prerequisite, especially as most of us get degrees that require discipline and real learning, will make a lot more sense when you start working with the amateurs.

 

[jules922]

In 6 out of 8 med school interviews I had, I was asked what my favorite non-science classes were ... and those questions inevitably lead to some interesting discussions about Russian politics, the work of Gabriel Garcia Marquez, NAFTA, etc., etc. ... it seems to me adcomms are looking for people who are well-educated in many areas. Not a bad idea in a profession that is so influenced by and interlaced with issues of politics, policy, culture, psychology, ethics, etc. You need to know more than science to be an excellent doctor.

 

[dutchman]

According to a federal survey, in 2000, nearly half of all nurses have a BSN or Masters/PhD. The proportion of nurses with diplomas and associate degrees is holding steady and the growth in the population of registered nurses is in holders of degrees. For at least 10 years it has been the position of the leadership of the nursing profession that the BSN should be the minumum preparation for a career in nursing. Consequently, the "business" of RN to BSN programs is booming.

So, while some of you are trying to push medicine back to the nineteenth century, nursing is pushing forward to produce even more highly educated professionals.

Hence we should allow Nurses to take over physician responsibilities and give the "physician extenders" autonomy? The main problem I have with your argument is that you are a medical educator. That means that you are the very person selling physician training to physicians. For you to come out and imply that midlevels should be given physician responsibilities will also mean you believe that they are adequately trained to handle those responsibilities. Which means that the 160K you are charging our primary care doctors for medschool, and the ~three years you hold them hostage in the name of residency is really a waste. What you are basically doing is telling primary care doctors they just wasted their time and money going to school, as all they needed was just midlevel training. That is a slap in the face from the very person that sold them the commodity.

If you really believe what you are saying then the morally right thing to do is shut down your primary care residency programs, cut down your number of medstudents by the percentage that goes into primary care. Convert that percentage to midlevel training spots, and charge them the same tuition you would charge a midlevel trainee.

Another problem with this whole argument that "physician extenders" will solve our problems of underserved communities is that; we seem to assume midlevels are not human beings subject to the same socio-economic dynamics that has made physicians not go to underserved communities to practice. You cant simply assume that midlevels are just waiting to be released so they can jump into the city of Compton to start taking care of business.

 

[albaniandoc]

According to a federal survey, in 2000, nearly half of all nurses have a BSN or Masters/PhD. The proportion of nurses with diplomas and associate degrees is holding steady and the growth in the population of registered nurses is in holders of degrees. For at least 10 years it has been the position of the leadership of the nursing profession that the BSN should be the minumum preparation for a career in nursing. Consequently, the "business" of RN to BSN programs is booming.

So, while some of you are trying to push medicine back to the nineteenth century, nursing is pushing forward to produce even more highly educated professionals.

Actually, I just read it was something like over 60% have an ADN. My mistake was that I was referring to the percentage of nurses in the OR that have a BSN. Recently, AORN published that data and the percentage of OR nurses holding a BSN was in the teens. My understanding of the study was that it represented a sample of all nurses not just OR so my mistake.

 

[LizzyM]

If the argument for making medical school shorter and cheaper is so that the graduates of said programs can serve poor communities without worrying about paying back a huge med school debt then they are making the argument for making it possible for people who have undergone a shorter, cheaper training period to serve in poor communities. We have those people already and they are called physician assistants and advanced practice nurses. There is a move to permit them to practice without on-site supervision. If some are arguing that these extenders are not adequately trained to provide care then there you have the answer to why we can't (or shouldn't) make the process to M.D. shorter and cheaper.

 

[BarrySanders]

If the argument for making medical school shorter and cheaper is so that the graduates of said programs can serve poor communities without worrying about paying back a huge med school debt then they are making the argument for making it possible for people who have undergone a shorter, cheaper training period to serve in poor communities. We have those people already and they are called physician assistants and advanced practice nurses. There is a move to permit them to practice without on-site supervision. If some are arguing that these extenders are not adequately trained to provide care then there you have the answer to why we can't (or shouldn't) make the process to M.D. shorter and cheaper.

When people question the training of doctors, they are referring to once in med school, residencies, fellowships etc. Nobody cares about someones undergrad schooling and how that relates to their training as a doctor.

Anyway, the few people who are arguing to shorten the process might as well stop now because for the most part people trying to be doctors (SDN)are nerds and just love school for what it is. Therefore, it is going to be awfully hard to convince them shortening the schooling requirement should be an option.

 

[LizzyM]

When people question the training of doctors, they are referring to once in med school, residencies, fellowships etc. Nobody cares about someones undergrad schooling and how that relates to their training as a doctor.

Anyway, the few people who are arguing to shorten the process might as well stop now because for the most part people trying to be doctors (SDN)are nerds and just love school for what it is. Therefore, it is going to be awfully hard to convince them shortening the schooling requirement should be an option.

I should have said "pre-med" training as it is the title of the thread. Some here on SDN are arguing that pre-med should be shortened. Some of us disagree.

 

[Law2Doc]

Some of us disagree.

Not to mention the fact that all of the folks with the power to actually change the system disagree, and the profession has steadilly and intentionally moved away from the position posited by the OP, over the years. None of this is accidental, despite the fact that the OP characterizes it as "unnecessary".