Friday, July 30, 2010

Do you really need hard core basic science in premed?

It may not be necessary according to this very small single institution study. Kids who majored in the humanities and skipped organic chem, physics, calculus and the MCAT did just about as well at Mount Sinai medical school as those who took the traditional path.

I have problems with this study, methodologically and philosophically. It was anything but a controlled study. The non-traditional students received a summer “boot camp” in basic sciences to meet state requirements. Baseline characteristics between the two groups were not compared, but it appears that the non-traditional students may have been a very select group on some measures. According to a New York Times report on the project the mean SAT score for the non-traditional students was 1444 (wow!) and “elite” undergraduate schools were heavily represented.

I have questions at a more basic level. I don't think anyone knows how much basic science preparation is optimal in either medical school or undergrad. Maybe we could do with a little less. Moreover, a better background in the humanities can only be a good thing. (You can still major in the humanities and meet traditional med school basic science requirements, by the way. Generations of med students have done it under the “old” pathway). On the other hand, and this is a purely subjective observation, I wonder whether we are seeing a dumbing down of medical education attributable to a gradual de-emphasis on basic science over the past two decades.

Organic chemistry was a pivotal course for premeds at my undergraduate school. It's one of those courses, at least when taught properly, where you can't get by with rote memorization. Basic concepts and patterns had to be understood and built upon. My professor was passionate in his belief that a fundamental understanding of the human body and the natural world was important for success as a physician.

When I see the pervasive move toward promotion and teaching of quackery in academic medicine these days I can't help but think we need more, not less, basic science.

More from DB.


Patrick Baroco said...

No organic chemistry = dumbing down? Meh. I was an English major (though as you note, met the requirements and ended up with a biology major, too), and a history minor. I barely passed organic chemistry--hated every minute of it, and thought about teaching instead of medicine. I did, in fact, quit the pre-med "track."

Got to med school, hated my first year, saw some light my second year, and knew I'd found my calling my third and fourth year. And I have been very successful (not monetarily--I am an internist, after all--but academically). I love medicine.

I think getting rid of requirements like organic chemistry will do nothing to "dumb down" med school classes. Indeed, to require the study of organic chemistry but not to require any significant study of the humanities sends, I think, the wrong message about what medicine is. It is a field that has one foot solidly in the sciences, and one in the humanities--but in its practice, I find it leans heavily toward the humanities.

Robert W Donnell said...

Watch out for the straw man here. I said in my post that I really don't know what's the optimal amount of basic science. There's also the question of how much should be in undergrad and how much in med school.

Basic science and the humanities? Of course you need both. Without the humanities you risk becoming narrow and one dimensional. Without the science you become incompetent. We could have a friendly debate about what's the best balance.

I didn't say dropping organic = dumbing down but I am concerned about the overall trend. Look at all the scientifically implausible garbage being promoted at academic medical centers now, being driven to a large extent by medical student initiatives. It's a dangerous trend and makes you wonder whether some students learned any basic science at all.

Patrick Baroco said...

Where is the straw man? You say we need "more basic science and not less." And are worried that less focus on basic sciences is leading to a "dumbing down" of medical education. That you seem to disagree with some of your own argument does not make it a straw man.

(By the way--I learned logic in my philosophy classes. Organic chemistry did nothing to help me recognize bullshit arguments. I learned how to do that in the humanities building.)

My point, and perhaps I was not clear enough, is that there is a requirement for organic chemistry and even physics--but there is no requirement for anything beyond freshman literature, for history, for philosophy (logic, for example?). To say we need even more basic science is the wrong solution. Organic chemistry has served me not at all. My humanities background has served me well on virtually every day of my career.

Robert W Donnell said...

What appears to be disagreeing with my own argument must be a failure to write with precision, perhaps attributable to the weakness of my own background in the humanities.

So here's an attempt to be more clear:

My comment about dumbing down was, as I said, a subjective observation. I said I "can't help but think" we need more basic science. I should have made it more plain, but the implication was that these are just my biases.

I made no evidential claim about how much basic science is needed. I don't think anybody really knows. I even allowed that perhaps we could do with a little less.

The straw man is attributing to me (as it seems you did) the simplistic and easy to ridicule position that "No organic chemistry = dumbing down."