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March 2001

Volume 21 | Number 2

Special Theme: The Premedical Curriculum

Required or Not? That is the Question
Edward N. Trachtenberg, Ph.D.
Jenette H. Wheeler, M.D.

It appears from many recent communications to both the NAAHP and NEAAHP listservs that advisors, and presumably their students, are seeking better guidance in the area of curricular advising. Should students be encouraged to go beyond the usual premedical science requirements and take more sophisticated courses in the natural sciences? Do these play a role in making a candidate more viable for admission? Is there a significant difference between candidates for the MD or DO and for those wishing to enroll jointly in a PhD program? Has medicine changed so much in recent years that students realistically will not be able to compete with their fellow applicants unless they have background courses in such things as biochemistry, molecular genetics, or physical chemistry. Are “recommended” courses essentially “required” because enough members of admissions committees will not support candidates who do not present them? How flexible are medical schools in waiving requirements, both in the sciences and in English and mathematics, if they have been taken in nontraditional pathways or have been substituted for? Do medical schools appreciate the importance of a liberal arts background, or do they view it as a luxury? Should we require that students learn Spanish? Should we gear our courses so as to educate (or perhaps a better word is train) students to take standardized exams? As we enter a new millennium, how should we address all of these questions?

John Hopkins University and Its Role in the Development of Modern Premedical Education
Ronald Harrison Fishbein, M.D.

The Plight of Premedical Education: Myths, and Misconceptions — Part II: Science 'versus' the Liberal Arts
Gert H. Breiger, M.D., Ph.D.

For decades it has been known that students who major in non-science fields perform as well as science majors who go to medical school. Yet the overwhelming majority of future medical students still major in biology or chemistry, and organic chemistry has come to be the defining premedical science course. This article traces the history of the liberal arts tradition, discusses its importance for medicine, and urges that readers think about the medical college in the age of the university. The author believes that the medical faculties should take a lead in helping to reshape the premedical as well as the medical education of future doctors. (Acad. Med. 1999;74:1217-1221)

Medicine: Art or Science?
Robert Stach, Ph.D.

The question of whether medicine is an art or a science is an important one to ask if students are to be educated in undergraduate school as well as medical school. If medicine is an art, then the training that students receive may still be appropriate. However, if medicine is a science, then students must be educated and not merely trained. Training and education are not the same thing. Training mainly involves the transfer of knowledge (i.e., information) to students; whereas, education involves, in addition to the transfer of knowledge, learning concepts and acquiring problem solving skills. Medical school training has not changed much over the past century; while there has been new information and even new disciplines added to the curriculum, there has not been a new pedagogy. Students have a multitude of facts to memorize. They have done this admirably, over the years, but they have less success with problem solving, a skill they must have in their medical practice. A physician brings together a variety of information and observations about a patient’s symptoms and draws a conclusion about the patient’s problem. To gain admission to medical school, a student has to excel academically as measured by the undergraduate grade point average and test scores, and have strong recommendations, service or health experience, etc. Therefore, one would assume that these students can think and readily solve problems. Unfortunately, a significant number of medical students cannot solve problems. To address this, many medical schools now use a problem-based learning approach, or something similar. Yet, medical students seem most capable of regurgitation and taking tests (e.g., MCATs) where they must be able to determine which one of the four or five answers correctly correlates with the information given in the questions. In our society, we have come to believe that the ability to regurgitate facts is an excellent sign of one’s capabilities. But is this really true? Statements by employers, both in the press and on the Internet, indicating dissatisfaction with the quality of students graduating from our high schools and colleges, suggest it is not. Most of these comments relate to the inability of individuals to problem solve (i.e., think). Does this mean that merely learning facts and regurgitating them is insufficient? In the past 10 years alone, we have had a burgeoning of biomedical information. Thus, it seems more necessary to cram even more information into the heads of medical students. Is this the way to handle this increase in information?

The Importance of Premedical Coursework to Success in Medical School
Rebecca E. Johnson, M.A.
Ellen R. Julian, Ph.D.

There has been a great deal of discussion among the medical education community and students about what premedical coursework is necessary for success in medical school (Muller, 1980; Stimmel, Smith, and Kase, 1995; Elam, Lenhoff, and Johnson, 1997). The debate has centered on the appropriate balance between science and non-science courses in the premedical curriculum. There seems to be a consensus that having an undergraduate non-science major does not negatively affect a student’s academic performance in medical school and residency selection (Dickman, et.al., 1980; Canaday and Lancaster, 1986; Hall and Stocks, 1995; Smith, 1998). Most medical school applicants however, still major in a biological or physical science as undergraduates.In 1984, the American Association of Medical Colleges (AAMC) published a report that recommended humanities and social sciences be included in any premedical curriculum (Muller, 1984). Since medical students have to deal with the consequences of their premedical education decisions, it seemed appropriate to ask them about what was necessary for success in medical school.

Therefore, this paper describes a research project that investigated what undergraduate courses were important to success in medical school and what a desirable balance between science and the non-science courses in the premedical curriculum might be, according to medical students and residents.

A Retrospective Look at Premedical Students' Majors
Peter S. Van Houten, Ph.D.

Throughout my 35 years as a pre-medical advisor I often heard the comment from students and parents that, “I hear medical schools are more interested in non-science majors than they used to be.” “Used to be,” when considered over 35 years, covers a great deal of time and should provide us with some evidence to support or refute this seemingly widely held belief concerning the value of a non-science major in the application process. As this remark has been made so often and over so many years, I became interested in determining if there was any basis in fact for it, and if so, was there evidence to indicate that premeds were responding to it and thus increasing the number of medical school applicants from non-science majors. Surely, one could imagine, if the word got out to premeds that their chances for acceptance were better as non-science majors, a considerable number would act accordingly and major in something other than a typical premed major such as biology or chemistry. We know that premeds do a rather good job of “keeping their ears to the ground,” i.e., being attentive to rumors.

Armed with copies of Medical School Admissions Requirements (MSAR) starting in 1966-67, the year I began advising with the naive notion that all premeds at Berkeley were zoology majors, I undertook an examination of evidence on the majors of US medical school applicants and their acceptance rates. It appears that MSAR did not begin to publish comprehensive data on the major of applicants until the 1972-73 class. Over the years, the format and content of what we now know as Table 4B in MSAR — Acceptance to Medical School by Undergraduate Major — has changed somewhat, making absolute comparisons impossible. Nevertheless, the basic structure has remained much the same, thus allowing adequate comparisons to be made. Data for the 1982-83 entering class were not available. My data end with the 1999-2000 entering class Thus, the data I examined cover a period of 27 years, a great deal of “used to be.”

The Mount Sinai Humanities and Medicine Program: An Alternative Pathway to Medical School
Mary R. Rifkin
Kenneth D. Smith
Barry D. Stimmel
Alex Stagnaro-Green
Nathan G. Kase

The Pre-Medical Education Enhancement Project (PEEP) — A Call for Action
Miles J. Schwartz, M.D., F.A.C.P., F.A.C.C.

In undertaking any consideration of issues involving medical education it is more than appropriate to reflect on the views of Sir William Osler. In 1906, Dr Osler commented: "The hardest conviction to get into the mind of the beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation."The phrase 'life course' serves to introduce the very issues I wish to address. We are concerned about two interlocking educational challenges as a part of the premedical experience: preparation for (1) a life in medicine, and (2) a life wherein medicine is a substrate for a wide variety of intellectual, social and physical activities..

From the Literature

Attributes of Graduating Students: Entry-Level and Beyond
David A. Heath, O.D., Ed.M.

This issue of Optometric Education contains an ASCO report entitled “Attributes of Students Graduating from Schools and Colleges of Optometry.”This report represents the conclusion of a multi-year effort by ASCO member institutions to define and communicate the core outcomes of Doctor of Optometry degree programs in the United States. The report was accepted unanimously by the ASCO Board of Directors at their annual meeting on June 20, 2000. This important effort by ASCO: (1) provides a common basis for curriculum planning and assessment at each of the schools and colleges of optometry; (2) assists optometric organizations in carrying out their functions as they relate to entry-level competency and post-graduate education; and (3) provides a clear understanding of the outcomes of an optometric education to non-optometrists and external agencies. Each of the other health care professionals has similar documents. (Optometric Education 26:1, Fall 2000)

Attributes of Students Graduating from Schools and Colleges of Optometry
David Heath, O.D., Ed.M.
Kent M. Daum, O.D., Ph.D.
Anthony F. DiStefano, O.D., M.P.H.
Charles L. Haine, O.D., M.S.
Steven H. Schwartz, O.D., Ph.D.

Doctors of Optometry (American Optometric Association definition)

Doctors of optometry are independent primary health care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions.

Optometry — A Responsible Profession

Endorsed by the American Optometric Association (1996) and The Association of Schools and Colleges of Optometry (1996)

The profession of optometry fulfills the vision and eye care needs of the public through clinical care, research and education, all of which enhance the quality of life. The scope of optometric knowledge and practice includes the prevention, examination and evaluation, diagnosis, rehabilitation, treatment and management of disorders, dysfunctions, and diseases of the visual system, the eye and associated structures; and the evaluation and diagnosis of related systemic conditions.

Optometric practice is dynamic, with the emphasis on patient care services at the general practice level. Responding to the changing needs of society, the profession must have access to all methods and modalities of contemporary practice.

Entry-level competencies include the professional attitudes, skills and knowledge to ensure safe and effective patient care outcomes and to support life-long learning. The maintenance of continuing competencies and professional growth must be ensured by continuing learning and assessment, and thereby it sustains the integrity of professional licensure. Additional education and training provide advanced practice skills and knowledge in specialized areas beyond those requisite at entry.(Optometric Education 26:1, Fall 2000)

Liaison Report
Saundra Herndon Oyewole, Ph.D.

Book Review: Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care
Book by Kenneth M. Ludmerer
Review by Robert Cannon, Ph.D.

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