Undergraduate Preparation of Medical Students

June 5, 2009

An editorial in this week’s Science describes the report of a committee of medical school and undergraduate faculty convened by the Howard Hughes Medical Institute and the the Association of American Medical Colleges concerning the undergraduate coursework preparation of medical students. I was struck by this particular conclusion:

Medical school faculty have a short time in which to convey an in-depth understanding of specific medical knowledge and recent research. Students should arrive at medical school prepared in the sciences, including some areas not currently required, such as statistics and biochemistry. If all beginning medical students understand general biochemistry, for example, then faculty can build on this knowledge, creating more opportunities to explore the synergistic relationships among biomedical science, research, and clinical medicine. Medical schools should also increase their emphasis on the importance of the physical sciences and mathematics in biomedical research and clinical practice.



14 Responses to “Undergraduate Preparation of Medical Students”

  1. Um….duh?

    I just assumed that this was assumed. It wasn’t? Med students didn’t previously have to have a solid background in the sciences?

    I knew some pre-med undergrads who were history majors and the like. But they still took all the science classes coz there ain’t no way no how they were going to to get an admissible MCAT score if they didn’t.

  2. Sven DiMilo Says:

    Speking for my undergraduate-training self, I would be happy to substitute biochem for the useless year of organic chemistry our students have to suffer through now (thanks, it’s my understanding, to medical school requirements), and stats for calculus and/or physics.

  3. Phledge Says:

    Our prereqs included neither biochemistry nor statistics. I happened to have taken them both, and it bothered me that my classmates struggled so horribly–even when it seemed to me that professors, erm, dumbed it down for them. Well, the curriculum designers only gave biochem profs six weeks to cover the medically relevant biochemistry. If I hadn’t taken it before, I would have been drowning too. It does nobody any favors to not make it a prerequisite.

  4. Hmmm. Entering med school with the bare bones minimum of general bio, introductory physics and a couple of chemistry classes, with maybe a Calculus AB course thrown in, as is possible for students who majored in humanities but who excelled in a pre-med post-bac program. . . that always sounded intimidating to me. It’s no joke to leap headfirst into a graduate program when you’re the only one of your cohort without either a major even remotely related to your field or any industrial experience in it. Going to med school without a substantial amount of science under one’s belt always struck me as the same sort of situation.

    Statistics classes are underrated, too.

  5. Arlenna Says:

    We’ve been working on revamping our gen chem, organic chem and biochem to address these needs–and my teaching mentor (who is awesome at this stuff) and his collaborators on the project are talking to a lot of the “right” people in HHMI and AAMC about the idea, too.

  6. Wait a minute … biochemistry ISN’T currently a standard pre-med course? Shit, I had to do general biochem in my applied physiology undergrad degree … and then field-specific biochem after that.

    This might seem like a stupid question, but what are pre-med students doing if not biochem? English? History?

  7. To me the strangest thing is that pre-meds don’t WANT to take these classes. I would think that if I had decided that my life was going to be spent making decisions about other people’s medicine, I would want to know everything I possibly could to prepare.

    Many a pre-med, however, seems more interested in taking the easiest or fewest classes, and getting As with the least effort possible, than in preparing for his future life. Fix THAT shit.

    Or, I guess, increase the pre-reqs.

  8. Eugenie Says:

    hm. Now I know why my university has a mid-90% acceptance rate for medical schools…

  9. Biochem isn’t a med school requirement across the board, but out of the 16 schools I applied to 14 required at least 4 credits and generally 6 credits of biochem.

    @Dr Jekyll: The premed students who are trying to take the easiest classs possible get a pretty rude awakening in med school. At my institution, I know a few who washed out.

    @Prof in training: I believe what most schools require is 6 creds physics, 6 inorganic chem +2 semester chem lab, 6 organic chem +1 smester ochem lab, 1 semester calculus, 6 credits bio+2 semester bio lab.

  10. leigh Says:

    wow, wtf. i was a biochem major, and about half my cohort were premeds. the other half were some other biomedical science major because biochem was too much for them- wimps.

    but all of em had to take organic chem from the most hardassed prof in the place. that ruined lots of potential medical school applications.

  11. This triggered a reminder of a discussion we had at my place last summer following a NEJM article by Jules Dienstag on modifying pre-med training.

    CPP also held forth then, as now, that the physical sciences (esp p-chem) provide an emphasis on quantitative reasoning that should be required of incoming medical students. I still defend organic chemistry as well. But I also submit that biochem should also be required prior to med school.

  12. Wow Biochem was a prereq for gradschool, if you didn’t have it you had to take a refresher course in the summer before school started. If they can require organic for the med school weenies then they should also require biochem.

  13. Denis Alexander Says:

    If all medical students learned about the fact that animal research is an integral part of medical research than we would not have to deal with Vlasaks or Greeks in the future. For every fact you present your medical student, show the creature that helped in its discovery.

  14. Bumerry Says:

    As a person who occasionally depends on doctors to save my life, I would prefer that they were required to demonstrate prior to med school admission:

    1. An aptitude for UNDERSTANDING medical and scientific research. I really couldn’t care less if they are brilliant scientists themselves. I sure as shit don’t care if they’re good at physics. I want them to know that epidemiology can never establish causation. Correlation does not establish causation. Period. Ever.

    I want them to know they need to read their journals weekly, and that they can’t rely on the authors’ conclusions but need to read the WHOLE paper and draw their own conclusions. The ability to understand basic genetics and MZ vs. DZ twin vs. parental concordance is needed. Knowledge of the relative scientific strengths and weaknesses of quantitative and qualitative research should be firmly in place as well. With rare or currently untreatable illnesses, and even healthy conditions like pregnancy where you can’t just randomly assign treatment and no-treatment groups, following a population clinically is both ethical and informative.

    2. An ability to LISTEN to what patients say and what they don’t say, and draw correct conclusions then check with the patient (and witnesses) to clarify. This can be done in seconds in an emergency. A couple of social work courses in assessment would instill this critical ability.

    3. A basic understanding of human psychology, including but not limited to: human developmental stages; motivated behaviors (thirst, sleep, hunger, breathing, pain, pleasure) that are not under a person’s control; a class on the biological basis of addiction (neurologically similar to epilepsy) as opposed to psychological dependence (which happens equally with marijuana, hugs, and asthma inhalers), and last but not least the common mental illnesses.

    4. Female anatomy, physiology and health (including pregnancy) as a medical norm equivalent to male anatomy, physiology and health.

    5. While we’re at it, how about a grounding in health (including pregnancy) on which to build a separate and parallel knowledge of pathology. I want doctors to recognize the natural variation in human phenotypes, and the effects that harsh or oppressive environments have on individuals and groups over time.

    6. Economics, including a thorough review of the cost of treatment and medication compared to the typical income levels of different populations, so that they will not label poor people “non-compliant”.

    7. Ethics – so that when they see other doctors abusing or butchering patients, they REPORT them to the police. And so when they are having trouble themselves, they seek help instead of harming patients and relying on other doctors to cover for them.

    8. A medical history class detailing health and science fads that are still with us today. Positive fads are important, but aversion fads are critical to understanding that one’s own biases can cloud clinical and scientific reasoning.

    I’d rather be treated by an English Literature BA or Auto Mechanics AD with those skills than a double major Biochem/Physics undergrad without them. It amounts to ten undergraduate classes at the most, only two semesters even for relative slackers.

    And while we’re at it, I want working interns, residents and attendings to get at least 8 hours of sleep in 24. I’ve nearly been killed by doctors who were so sleepy they couldn’t have counted to ten if asked. Fortunately, either nurses took over and TOLD the comatose docs what to do, or I was an asshole and demanded a doctor who was competent to make legal decisions, let alone diagnoses and treatment decisions. How can people emerge from even a basic biology class without understanding that humans need sleep?

    I guess I needed a rant. Hopefully you did too. 🙂

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