Reform of premed education under way

In 1910, Abraham Flexner’s examination of the state of American medical education led to widespread reforms in the way doctors are trained. Today, another evaluation is under way that could have equally far-reaching ramifications for future physicians.

The Committee to Establish the Scientific Foundation for Future Physicians, organized by the Association of American Medical Colleges and the Howard Hughes Medical Institute, is studying the standard premedical curriculum to make it more relevant to the practice of modern medicine.

Robert J. Alpern, M.D., dean and Ensign Professor of Medicine, the committee’s co-chair, said it took the committee only a single meeting to identify the problem: while science and medicine have changed dramatically since the days of Flexner, the premed curriculum has remained static. Organic chemistry, the bête noire of almost every premed student, is a required course although the relevance of some components of the course to medicine is marginal. At the same time, such crucial subjects as statistics, biochemistry and genetics aren’t required at the undergraduate level.

Another problem, Alpern said, is that the premed curriculum often serves as a gatekeeper to weed out students. “I’ve actually spoken to organic chemistry professors who pride themselves on being the ones who determine who should go into medicine,” he said.

The 19-member committee, drawn from both medical schools and undergraduate institutions, has been meeting for about a year and a half. It’s working on recommendations that will be presented in a report this year.

The key proposal, Alpern said, is to replace required courses with “scientific competencies”—the knowledge and habits of thought that a student should have upon entering medical school. “We want to get away from telling colleges, ‘You need to have a course in this or a course in that,’ ” he said. “We want to say, ‘These are the competencies someone should have.’ ”

Alpern anticipates that this approach will reduce the importance of organic chemistry in favor of biochemistry. Similarly, the mathematics curriculum will shift away from calculus and toward statistics. Alpern also hopes that professors will develop interdisciplinary courses that illuminate the medical relevance of premed coursework and that standardizing what new medical students should know will free medical school professors from having to teach to the lowest common denominator.

The impetus for revisiting the premed curriculum came from the National Research Council’s 2003 BIO 2010 report, which found that fewer American students are becoming research biologists—in part because of the premed requirements. “When premed students got tortured in organic chemistry, people thinking about careers in research biology got tortured along with them,” Alpern said.

Committee members plan to seek feedback from certain medical and undergraduate educators before disseminating the report to the undergraduate and medical school communities. The committee knows it will be easier for wealthy colleges to revise their curriculum to accommodate these changes.

In a parallel effort, a new committee has been formed to revise the MCAT, the aptitude test that students take for admission to medical school. The work of these two committees must be integrated for change to occur as it requires coordinated modifications in premed requirements, the MCAT and the undergraduate curriculum. Alpern predicts it will take some years before students see any changes, because directors of undergraduate programs will need to know how the MCAT will be revised before they can change their curricula.

“It’s not going to happen overnight,” he said, “but when it does, I think it will represent a major transformation in medical education.”