Should some ditch the pre-med path?

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Mind your Faulkner

In today’s Midmorning program, Kerri Miller talked to two physicians about how some medical schools – including Mt. Sinai Medical School in New York -- are taking in some students with nontraditional backgrounds.

A recent Mt. Sinai study indicated that students with humanities backgrounds perform just as well in medical school as those pre-med students who come from the more traditional science backgrounds.

Talking on the subject are:

John E. Prescott, M.D., chief academic officer for the Association of American Medical Colleges; and

Jon Hallberg, M.D.: assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota. He runs the Fisch Art of Medicine Student Awards program. Dr. Hallberg is a regular commentator on Minnesota Public Radio's All Things Considered.

 Here are my edited notes on the discussion, which includes various callers, their questions and opinions.

Some medical schools may consider this a bit of a risk – diverging from the idea of how students should be prepared.

Prescott: Medical schools are trying new things all the time to produce the best physicians for the future. Mt. Sinai’s program is an attempt to do something different and to see if it works and is applicable to other med schools. The humanities students represent only 12 percent of the class. It seems to work when you take highly select individuals, put them into rigorous programs and mix them with more traditional students.

It seemed like there was a lot of caution about the idea.

Hallberg: Medical schools have admitted humanities majors for decades, but required them to take the Medical College Admission Test (MCAD), physics, organic chemistry, etc. Mount Sinai is different in that it admits those students fairly early, has them maintain a 3.5 GPA, and puts them into interesting summer prep courses like organic chemistry that are much more applicable to medicine. They might take physics, but they learn just enough to understand things like optics, or the physics in orthopedic surgery. Stuff like that. This is a pretty radical departure. Even the University of Minnesota has a wonderful new relaxed admissions standard, but it still uses the MCAT.  If that’s the case, when you have 3,000 applicants for 170 spots, you have to have something that culls through all that. So you’re stuck trying to think in a forward fashion, but you still have to determine who’s going to succeed in med school.

The default questions are still: How did they do on the MCAT? In organic chemistry? What’s their GPA? That excludes a lot of kids.

Prescott: I think the MCAT exam does exactly what it’s supposed to do: help predict who’ll do well in medical school and who can handle the load. Are there some students who don’t get in because of lower MCAT scores or a lower GPA? Absolutely. But we’re looking at ways to make sure that students who are qualified in other ways and can handle the work of medical school have opportunities to get in.

(Caller): I think this is a really good movement. I’m a medical student with a social science background. During my first year, I got very little time to explore the humanities. I felt that a big part of me involved in humanities is gone. But that background still gives me a better perspective, and I hope I can go back to that later.

Hallberg: I don’t think Mount Sinai is intrinsically different from other programs once you’re in the actual medical school. Your life is put on hold for two years. The first two years are spent memorizing facts, which is sad. Imagine the amount of information, the mind-blowing stuff taught to you, and to think you have to regurgitate it at the end in a test -- it’s sad. You can’t enjoy it. It’s like organic chemistry. It’s fascinating information, but because you have to study for it and it’s a weeder course, it’s not fun.

Would it be meaningful for medical schools to allow more humanities involvement once students are in medical school?

(Caller): There’s so much (medical) material you need to learn, I don’t think there’s much space for it.

(Caller): I’m a doctor. I definitely agree that we need a well-rounded physician who can tackle all of the challenges that come with being a physician. I wouldn’t know how to do organic chemistry at this point. I almost question the need for it in medical training. On a different note, it would be important to have some business training. Someone coming from that background would be helpful.

Hallberg: I have a 1,000-page organic chemistry book. It’s absolutely a foreign language to me.

Why are students headed to med school required to take a class (in organic chemistry) when already two doctors have said they never use it?

Prescott: There are many valuable competencies that people can take from that organic chemistry course. That’s what was revealed in a joint study just released last year. There are competencies that students should have before med school. It’s not so important that you complete a class in organic chemistry or calculus, but perhaps it’s those key concepts that will help you better understand how drugs work, or how antibiotics work. That’s what we’re aiming for.

Some say that standardized tests such as MCAT or the LSAT are statistically a less predictable predictor of success than the GPA.

Prescott: I’d have to disagree. We have good evidence that the MCAT is far and away the best test in regard to how students will do in medical school, and does outperform the GPA. We’ve looked pretty closely.

But Mount Sinai doesn’t require the MCA for this special group of humanities students.

Prescott: Yes, but those who did take the MCAT had to do pretty well to get into Mount Sinai. This is a pretty smart group already. But if you add up the scores, you have an average of 36 out of 45, so it’s a pretty good score.

(Caller): I’m a former physician who’s now an artist. I went to a nontraditional medical school in Kansas City – the University of Missouri. It was a 6-year program for those straight out of high school. There was no MCAT requirement, so admission was based on things like GPA, SAT scores, volunteerism, etc. The program took in a group of students, put them into a medical setting, and had them spend two years on the main campus taking the basic sciences. They also had a hospital class with a docent once a week where we’d go see patients. The last four years we were in medical school, but for one semester in the third through sixth years, we’d go back to the main campus to take more classes. It was year-round with a month off. I have an English literature minor, and one fellow in psychology double-majored in literature. They actually started a department of humanities at the med school. I think although we had some drop out in the first two years, that may have had something to do with them being straight out of high school. The majority went on to become successful physicians.

Hallberg: That program has very interesting, well-rounded people. It’s is like one in England, where you go into medical school from high school. There is no four-year degree first, as we have in the States. Students are tracked from high school in the rest of the world. (The caller’s) program is much more international.

Prescott: A number of graduates have done very well. But that program has its own challenges when it’s taking students from high school. There are a number of individuals who find out it’s not for them. There are concerns with regard to the program.

(Caller): I’m the proud parent of a student in the Humanities and Medicine Program at Mount Sinai. It allowed my daughter to take a year off after college to study different things and travel. It enriches the experience. I hear that the Humanities and Medicine students tend to go into primary care. So many students have big student loans and go into sub-specialties to make more money to pay off loans and so don’t go into primary care and such fields, which we desperately need.  I only hope more medical schools go into this direction. We need the people connection.

 Would we get more well-rounded doctors if we have more nontraditional students?

 Hallberg: It sounds incredibly humane. They have a more humanistic bent. They acknowledge that their program might not work in Minnesota or other parts of the country, but the idea is very hopeful and very intriguing. Tailoring the pre-med experience and allowing students to tailor own paths is great. I hope it takes off in this country.

Do you get more diverse doctors that way?

Prescott: You’re hitting an important point. It depends on how you define diversity. What is their racial or social-economic background? Can they work with teens? Do they have good communication skills? We need to make sure we’re admitting students with those qualities.

(Caller): I’m a third-year medical student at the University of Minnesota. In the first couple of years, it can seem you’re at a disadvantage when you have a background like mine – political science -- because of the lack of medical and science knowledge. But in the third year, things like being compassionate to parents, communication skills, ethics, even writing skills, are important. Then my background becomes an advantage. Any smart person can learn the technical material, but things like communication, writing and ethics are harder to teach, and med schools aren’t well-equipped to teach those things.

So what we want are empathetic, curious, free-thinking, interested-in-the-world doctors, right?

Hallberg: That’s right. Ninety percent of what we’re doing is about communication in one form or another. Underlying it is science, but it’s still about communication and people skills.

(Caller): We see benefits on the other end, too -- other benefits to society. I know laws influenced by the medical profession. One example is health-care legislation. A lot of people in the medical field are not trained to think about law or economics.

Prescott: He’s onto a good point. Usually we hear this debate from an either/or standpoint. You can be a biology major and still be exposed to ethics or literature. It’s not either/or. We are looking for individuals who can contribute in many ways in society.

Hallberg: Pre-meds are usually bashed in college, and it sometimes seems they’re only worried about their grades. But they have incredibly integrated studies – including science and humanities. Most students don’t have to have their feet in only one camp. It’s actually pretty balanced. It’s sad that 80 percent of students do the pre-med major, and I think it’s because they’re getting the wrong message from high schools. But it has never been a requirement.

Prescott: We need to emphasize that there are multiple ways into med school. You can be a philosophy major, and we do encourage that.

(Caller): I was a chemistry major with a PhD in history. The first years were difficult, because my science background didn’t directly help. I have a lot students who’ve gone into medicine. And a lot have a science curriculum that’s so tough that they don’t have time for humanities. I encourage them to read the book, The Spirit Catches You and You Fall Down. It’s a tragic story of Western medical practices and how two different worlds clash. You may be proficient in math and science, but most of medicine is about the human condition. Humanities help prepare you with dealing with the human condition and relating to people. My father-in-law, a physician and former residency director, was surprised that his medical students really struggled with how to relate to people. A book he assigned to them was The Spirit Catches You and You Fall Down.

Prescott: We need to make sure we have students who can communicate well and listen to patients and understand cultures.

So it’s like you need to know anatomy, but you also need a deep understanding of the human condition, which involves philosophy and on down the list.

Hallberg: That book was required reading at the University of Minnesota. Now it’s Mountains Beyond Mountains that will be the staple text. But reading anything illuminates the human condition.

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