During my junior year of college, I waited in line with classmates to use a chemistry lab scale. We held fragile containers with an unknown white powder and had to identify the mystery powder using techniques like chromatography, distillation, and recrystallization. It was the most important lab of the year in organic chemistry.
Suddenly the girl next to me dropped her container. Her grade, her future, her hopes depended on that powder falling to her feet. When the container hit the floor, sending white dust across the floor, a nearby classmate pumped his fist and blurted out, “Yes!”
This is what it’s like to be pre-med.
Next month, students around the country will begin submitting their applications to medical schools. When we talk about the rigors of becoming a physician, we tend to focus on some classic rites of passage, like anatomy lab or intern year. But pre-med can be one of the most brutal and dehumanizing parts of medical training.
Medical school applicants generally have to complete a series of basic science courses, including biology, chemistry, organic chemistry, and physics. These requirements came to be after 1910, when the educator Abraham Flexner wrote a report on medical education for the Carnegie Foundation. Back then, medical schools had lax admissions standards and inconsistent, nonscientific curricula. But Flexner argued that medical training should be science-based and that applicants should complete undergraduate coursework in basic sciences in order to apply.
His recommendations were transformative. Since Flexner’s report, basic science classes have formed the foundation of how we screen aspiring doctors in the United States. Medical schools across the country have since required applicants to complete some variation of these core classes, and the Medical College Admission Test (MCAT) has largely focused on these subjects.
But this system of pre-med is outdated and broken. It has to be fixed.
The first issue is that the required basic science classes have become largely irrelevant to modern medicine. Ask any medical student or physician how much they use knowledge from their pre-med classes. They’ll probably laugh at you.
Do primary care doctors use atomic orbital theory or SN2 reactions in clinic? Do surgeons need to know black body radiation or Schrodinger’s time-independent equation to care for patients?
Of course, physics can help future doctors understand blood flow, and chemistry can teach students about drug receptors. But virtually every college class, from financial planning to gender studies, has some relevance to medical practice. The question is which core classes will best identify and prepare future doctors.
Instead these basic science classes have turned into factories of cutthroat competition. At many colleges and universities, these classes have become the gateways to medical school and fill up with hundreds of anxious pre-meds. For example, in 2009, my introductory chemistry class at Cornell had over 820 students, all of us trying to distinguish ourselves from the heap.
Making matters worse, professors frequently grade students on a curve. In other words, students’ grades don’t depend on their own performance, but rather the comparison to their peers. That’s why my classmate pumped his fist when the other student dropped her powder sample in chemistry lab. He literally benefited from her misfortune.
These classes have come to be known as “weed out” courses for their role in culling the students who can’t cut it. Indeed I know plenty of classmates who would have made fantastic doctors, but fell victim to this brutal process.
I remember once studying with a brilliant classmate before one of these exams. He hoped to be a doctor, but became discouraged by pre-med coursework and eventually switched career tracks. That night, as we sat at a library table, surrounded by textbooks and papers, he looked up at me and asked, “Why do we have to do this to help patients?”
I’m not sure. We all want compassionate, well-rounded physicians to care for us. We want doctors who can work in teams and who put patients’ interests first. Yet our current pre-med system bears little relationship to the practice of medicine and encourages students to focus on their own success above all else.
We should look for budding doctors who dream of caring for patients and spend their college years developing diverse passions. Students who study the injustices of socioeconomic disparities, the intricacies of music theory or the beauty of poetry can also make great physicians.
Research backs this up. Since 1987, the Icahn School of Medicine at Mt. Sinai has run a Humanities and Medicine Program (HuMed) that admits non-traditional applicants who haven’t taken the usual pre-med requirements. In 2010, faculty there published a study of hundreds of students and found HuMed students and traditional pre-med students performed at virtually the same level in medical school.
Mt. Sinai has since expanded this program, and more medical schools have followed suit. Last year, the American Association of Medical Colleges released a new version of the MCAT that includes sections on social sciences and psychology. These are encouraging reforms, but we need to do more.
More than a century ago, Abraham Flexner recognized that medical education should be science-based. But we’ve since taken his recommendations too far. Today we “weed out” potentially wonderful doctors through a demoralizing maze of basic sciences that more often resembles the Hunger Games than a sensible recruitment process.
It's time for a new Flexner report. It's time to reconsider what we value in our physicians.
