The New York Times today has a story with the provocative title Getting Into Med School Without Hard Sciences, about a program at Mount Sinai that allows students to go to med school without taking the three things most dreaded by pre-meds: physics, organic chemistry, and the MCAT:
[I]t came as a total shock to Elizabeth Adler when she discovered, through a singer in her favorite a cappella group at Brown University, that one of the nation’s top medical schools admits a small number of students every year who have skipped all three requirements.
Until then, despite being the daughter of a physician, she said, “I was kind of thinking medical school was not the right track for me.”
Ms. Adler became one of the lucky few in one of the best kept secrets in the cutthroat world of medical school admissions, the Humanities and Medicine Program at the Mount Sinai medical school on the Upper East Side of Manhattan.
I’m kind of torn about this. On the one hand, I tend to think that anyone who is going to be allowed to prescribe drugs ought to know enough organic chemistry to have some idea how they work. On the other hand, though, I would shed no tears if the pre-med physics class disappeared entirely– most of the students resent having to take physics, and I’m not wild about being used as a weed-out course for somebody else’s major program, which is a combination that easily turns into a thoroughly miserable experience for everyone.
The story cites a new study of Mount Sinai’s program, which finds that the students from the Humanities and Medicine program are statistically no worse than their classmates from more traditional pre-med tracks. The only statistically significant differences in their performance are slightly lower scores on the licensing exam, slightly higher incidence of taking a non-academic leave of absence, and a higher tendency to go into psychiatry. I’m pretty sure a friend of mine went through this program, and I don’t think I have any qualms about him being a doctor.
Still, I’m a little uneasy about people getting to be doctors without taking science in college at all:
The students apply in their sophomore or junior years in college and agree to major in humanities or social science, rather than the hard sciences. If they are admitted, they are required to take only basic biology and chemistry, at a level many students accomplish through Advanced Placement courses in high school.
They forgo organic chemistry, physics and calculus — though they get abbreviated organic chemistry and physics courses during a summer boot camp run by Mount Sinai. They are exempt from the MCAT. Instead, they are admitted into the program based on their high school SAT scores, two personal essays, their high school and early college grades and interviews.
I suspect Mount Sinai has good results from this program because it’s just about the only one going, and they get their pick of the very best students, who are able to pick up what they need from “summer boot camp.” I’m less comfortable with the idea of making this a general policy– a lot of the students I see struggling in pre-med physics are struggling because of things that would not be positive features in a doctor.
(I don’t give a damn about the MCAT, by the way. Like most standardized tests, this exists primarily as a way to line the pockets of ETS while reducing the workload of med school admissions offices. It’s perfectly possible to imagine a system in which nobody takes the MCAT and we still end up with excellent medical staff. It would be a lot more work for people reading med school applications, but such is life.)
So, as I said, I’m torn. What do you think? Would you be comfortable moving to a system where future doctors don’t have to take physics and chemistry in college?
This is the part I have the most trouble with. Shouldn’t the students at least have to take some advanced biology and chemistry, beyond the intro level stuff covered in AP classes? I agree that the MCAT is mostly not useful, but it would at least require people to learn some of that intermediate-level material.
a lot of the students I see struggling in pre-med physics are struggling because of things that would not be positive features in a doctor.
This is just right. Pre-med students should have to take physics and chemistry not because they need to be able to understand the harmonic oscillator or balance a redox reaction, but because they need to be able to think in the way that helps one succeed in those classes.
A related story: I once had a student complain to me that she was wasting her time in my Analytical Chemistry lab class because it would be irrelevant to her future career. When I asked what her plans were after college, she reported with a straight face that she would be attending pharmacy school.
No.
Doctors need to be educated people for lots of reasons, not just because they hold life-and-death power over others. I suspect that if it became the normal path, the overall intelligence and fitness of doctors to practice would decline.
But that’s just my view of the ideal world. In my ideal world, physicians are close to practical scientists. They should use a lot of the same skills a good data analyst uses to diagnose conditions. (Surgeons are different; they’re pretty much just mechanics.)
I realize that in the real world it probably wouldn’t make much difference in the quality of physicians and their ability to do good medicine. There would be good ones and there would be bad ones. And for the most part (the most part, not the full part) doctors would be what they are now, more along the lines of an engineer following all the rules of thumb than a scientist who understands where the rules came from and when they don’t apply.
Why are they required to not take the more advanced classes? What a strange idea. Is it just so statistics can be done on their outcomes and compared to the usual track?
Or maybe I’m misunderstanding and “required to take only” is intended to mean “only required to take”…
No. Physicians need to have a scientific background. The power of modern medicine is that it is science based. As a result, we are living longer, healthier lives. While an organic chemistry class by itself isn’t going to really make it possible for physicians to understand exactly how the medications they administer work, it will help. It may not be as clear why physics is important too, but if you read Orac’s post this morning, you might get some sense (biophotonic water anyone?). Finally, physicians continue to be held in high esteem in all communities. Their opinions tend to be listened too. I believe part of this is their rigorous education beginning as undergraduates and continuing through medical school. So, if others are going to really listen to what physicians have to say, I’d certainly hope that when they talk about science, they have a strong background in it.
most of the students resent having to take physics, and I’m not wild about being used as a weed-out course for somebody else’s major program, which is a combination that easily turns into a thoroughly miserable experience for everyone.
This issue is not unique to pre-meds. You also see it, though not to as great an extent, in engineering majors.
I agree with Chemist @2 that the primary value in having pre-meds take physics is so that they can include physics thinking in their toolbox. Whether the present day Physics for Pre-Meds courses achieve that goal is another question. While universities don’t face the sorts of pressures that secondary schools do to teach to the test, that temptation is certainly there for any professor unfortunate enough to be stuck with such a course.
Organic chemistry is a different matter. A doctor needs to know enough to develop a sense for interactions between medicines and the body as well as interactions among medicines. Whether currently-structured organic chemistry courses achieve this goal is a question worth asking.
I would say that they don’t, but that chemistry departments tend to offer classes (with the organic chemistry series as prerequisites) where students can learn this. In general, the students that end up in these classes are juniors and seniors who hope to go to graduate school in biochemistry, not pre-meds.
I don’t know if it’s realistic to expect pre-med students to take upper-division chemistry classes, though, if for no other reason than the emphasis on GPA in medical school admissions gives them an incentive to avoid as many difficult classes as possible.
What I’d want med students to learn, whether they get it from an intro lab course or any other way, is a basic understanding of what science is about, and a feel for physical and chemical laws. Essentially everything I’d want a med student to know about science is taught well by Mythbusters. I want them to learn about error-correcting mechanisms in science (repeating experiments, peer review), and that not just “anything can happen.” Physical law imposes constraints on “anything.”
Wait a freaking second. You are actually advocating for less science education in a field that still has people who are completely ignorant of how quantum mechanics and the laws of physics work?
What moronic engineers are you talking to?
If you dislike the premed physics courses, imagine how mathematicians feel about teaching calculus 🙂
It seems to me that doctors, as one of the more visible representatives of ‘science’ to the public, should be well versed in basic, established scientific fact. I have seen so many doctors on the web and face-to-face bather on and on about some scientific factoid as though he/she discovered it him/herself. Worse however is the fact that the public treats doctors as they ARE SMARTER THAN EVERYONE ELSE!
If there is not a real reason (like having to excel is several scientific disciplines) to believe doctors to be that smart, then society should be made aware of this fact so that we (as the public) do not depend on their opinions for scientific information.
I understand that this program does not produce the prototypical doctor, but if Mt. Sinai can convince themselves that sociologists should be the representatives of biology and chemistry to the public, why won’t other schools do the same in the future?
Physics saves lives! It keeps stupid people from going to medical school. 🙂
In my experience, physics courses teach you to think differently than just about any other science courses, and doctors can certainly benefit from that. I notice that people seem to be generally commenting that students need to learn the scientific thought process taught in physics courses, and not the specific physics knowledge itself. Why can’t they get this sort of back ground from the chemistry courses, or biology courses, or in medical school? Are physicists the only ones who understand that units are important and that measurements have some amount of error in them? Do the physicists reading this blog just not trust the other disciplines to teach it right? Or are the other courses leaving off some of these topics because they know the physics courses will cover some things?
I suppose my opinion can be distilled to this: I think a lot of basic chemistry knowledge is vital to being a doctor, a lot of basic scientific method thought process is important, and a small amount of basic physics knowledge is important. The system could probably be reworked to cut out some of the physics knowledge provided some of the general scientific training is still covered elsewhere. The entire educational process for doctors through a undergraduate degree and then medical school is a long complicated process, and courses teach more than just facts and equations.
(From my time teaching lab courses to the pre-med students, I have a private list of people who will never be my doctor. Anyone who week after week couldn’t figure out series vs parallel, or couldn’t learn to work a multimeter is on that list.)
Okay, then. If the doctors aren’t basing their diagnoses on biology, and their prescriptions on chemistry, then they’re making the strongest possible argument that they can (eventually) be replaced by expert systems.
Which is, actually, probably true.
I just don’t believe a human can operate that way.
I am obliged to complain about math/stats training of doctors (and scientists – I’m suffering from that today in fact).
Here we have people making important decisions, who often know almost nothing about decision theory – and it shows. They are often not competent to grasp the literature of their own profession despite years of training.
On the general issue of whether pre-meds should be able to get in with reduced science requirements, I think Chad is right when he says:
I see all sorts of reports on various educational experiments, and you can do damn near anything and get good results if you have really smart and motivated students and a passionate and hard-working instructor who truly believes in the approach being taken. That doesn’t mean that this will scale to a wider population of students in an educational atmosphere that hasn’t fully drunk the kool-aid and committed itself passionately to that particular approach.
So, yeah, most pre-meds probably need more science classes so you can sort the capable from the less capable.
On the specific question of whether physics or organic chemistry should be part of the advanced science requirements used to vet the masses of pre-meds as opposed to, say, biochemistry or physiology or whatever:
As much as I believe in the educational value of physics, I’m agnostic on whether physics as it’s usually taught should be a filter for pre-meds. If we were talking about a class taught from the book by Benedek and Villars, or Robijn Bruinsma’s lecture notes on physics and biology, or some other class that truly integrated real biological context into the class (as opposed to a very thin veneer) I’d give a whole-hearted endorsement to a physics requirement. This, however, would require the physics faculty to learn biology.
Also, however useful that sort of class might be for the pre-meds, it would be even more useful for the ones who go into research, medical devices, etc.
I want any physician dealing with my health to have enough knowledge of physics, at a bare minimum, to understand why reiki and homeopathy and their fellow travellers are bogus. Preferably more, but that’s the bare minimum acceptable to me.
Med schools should use physics courses less as weed-out courses and more as quack filters.
— Steve
I want my doctor to have a basic grasp of all science as well as to be interested in it. A doctor who does not respect and understand the basics of science and only focuses on their need to help people is a doctor that I believe would be more open to anecdotal evidence and quackery.
Med schools should use physics courses less as weed-out courses and more as quack
filters.A better phrasing just occurred to me; physics courses should be anti-quackery innoculations. I don’t want fewer doctors, but rather doctors more resistant to the Deepak Chopra-isation of their profession right when science is making such enormous advances in the field of medicine.
Teach ’em enough physics to understand why quantum mechanics don’t make “The Wish” a reasonable hypothesis and I’ll be eternally grateful.
— Steve
PS: Some training on critical thinking and statistical analysis might come in handy when dealing with pharmaceutical salesmen, too.
Disclaimer: Liz Adler is my cousin.
So I happen to know that she’s done a bunch of neuroscience research and biochemistry (as well as, for instance, setting up health clinics in Tibet and Uganda and treating Ebola victims as part of a med team – the article unsurprisingly overplays the ‘liberal arts med student’ aspect). If she’s a typical member of the program, I’d have no qualms about being treated by them.
However, I think Chad has it entirely correct: if the intake is smart and motivated enough, it probably doesn’t matter *at all* what they have taken formally in classes to that point. So if we wish to continue having the current number of med students, some filter is needed, and – as others have noted – that’s the role played by “hard” science classes. It’s a question of ability to think rigourously, not whether one happens to know the formula for aspirin.
Is there any evidence that force feeding science to students is a good thing? Pharmaceutical chemistry (which might be ‘relevant’) relies on so much background that it would be considered an advanced module in most chemistry degrees.
It would be nice if they could do basic stuff like calculate concentrations (I’ll leave out molarities, I’ve met PhD chemistry students who cannot do that!), which you might cover in an intro module, but I wouldn’t rely on a medic remembering enough to trust their prescription. I’m happier if the stuff they pedal comes in pre-packaged quantities!
I don’t know the specifics of the admissions process for Mt. Sinai, but I know two of my college classmates were in this program and they are both brilliant, hard working, and conscientious (and Phi Beta Kappa at your/our alma mater). I have no doubt they have filled any educational gaps they had at the beginning of med school and are outstanding doctors.
Given the number of really bad junk science/medical books I’ve seen written by people with MD after their names, I’m not sure the current system is doing very well at teaching critical and scientific thinking. I wanted to explain the concept of ‘selection bias’ to the neurologist who had recommended one of those junk books to me, but decided it probably wasn’t a good use of my appointment and I should just get the prescription for the drugs I needed to keep my migraines under control and ignore the junk science.
The problem with gatekeeper courses is that they turn into something to survive rather than something to learn. I’d like for future doctors to learn how to think critically and scientifically, though I’m not sure what the best way to accomplish that is.
Med school is about memorizing shit. The ‘chimistry’ or ‘pharmacology’ or ‘immunology’ they learn in med school is totally superficial– the very basics they need to function. So who cares whether they memorize physics equations or memorized dates of important battles or memorize opera songs in Italian as undergrads?
They simply dont do basic science as physicians, so why make that a requirement? Memorize the right stuff in med school, get practical training on rotations, theyll be fine.
Its the PhD students you want to understand physics, chemistry, evolutionary biology, etc.
ERV,
Med school may be about memorizing shit, but that’s not what being a doctor is about. I have lots of problems with medical education (i.e., it selects for people who are willing to step over their peers to kiss ass of those that grade them), but basic science has to remain a requirement. First, it’s not all about memorizing formulas, a good doctor (not too many of them out there) actually understands the science behind what they’re doing. Second, without a science background (as others have mentioned), doctors will become stupider than they already are (I know MD’s who have trouble with the concept of logarithms), and in turn it will hurt patients. What needs to be done is to get rid of standardized tests (MCAT’s, boards, etc.) because all they promote is memorizing, and require science, statistics, and actually test for concepts rather than memorizing names and numbers. It’ll quickly make better doctors and get rid of a lot of quackery out there.
If this option were widely available, half of lawyers would be M.D.’s instead.
First, it’s not all about memorizing formulas, a good doctor (not too many of them out there) actually understands the science behind what they’re doing.
You want MDs to be PhDs too. Thats not fair. They have to cram in a TON of information, so it has to be more superficial.
Im spending 5 years learning all the nitty gritty details of the science behind one aspect of one retrovirus. Its not fair to expect MDs to do the same thing for every aspect of every retrovirus. And every other RNA virus. And every DNA virus. And every bacteria. And every fungi. And every…
Med school is a totally different thing from graduate school. You can succeed in med school without knowing the stuff we worry about in grad school, and vice versa. Training to be an MD is totally different from training to be a PhD, because the careers are totally different.
If evidence based medicine becomes the norm medicine will move to being a set of checklists. The primary care physician will follow the checklist and its treatment. Only if something does not match the checklist will the patient be referered to a higher level physician. This is why primary care will become the home of nurse practitioners. As 8-10 years of post graduate (BS) education is overkill for it. It will be if you see x,y, and z then do a and b.
I’m not saying you need to know the nitty gritty at a PhD level, just understand some general concepts (i.e. know how to tell if a study is crap or good, or know how electric currents give rise to EKG readings). Yeah, unfortunately, to succeed in med school now all you need to do is learn to memorize and kiss ass, but that’s not what makes a good doctor. Medical education is in desperate need for change – and not in a direction away from science.
And I regret to say that the physics that we teach to biology majors, whether premed or pre-PhD or pre-whatever, does not really constitute understanding physics. For that, it would be better to put it in a meaningful context and use something like Benedek and Villars, Bruinsma, or something else in that genre.
In an ideal world, biology students who plan to get a Ph.D. in anything cellular or molecular would take Physical Chemistry and a physics course taught from this book.
Ehhh… I screwed up the post. Oooo that is really dam well comforting that your average electrical engineer who works on biomedical equipment has better science and biology background than the freaking doctor who uses it.
I call BS.
I’m seeing a whole lot of armchair doctoring type comments from people who seem to mostly interact with premed students, or preclinical med students.
Just to toss out how important foundational knowledge in the sciences are, I’d like to go over basic science points that I discussed a conversation I had with a med student while taking care of a patient with hypertensive emergency (flash pulmonary edema) in the emergency room.
We started with discussing feedback loops and control systems and pointing out that these systems generally have upper limits at which they eventually fail to function (important because blood flow to the brain is exquisitely controlled… within certain bounds of blood pressure, after which you get cerebral vasodilation instead of constriction, which leads to altered mental status from cerebral edema
Of course that lead us to hydrostatic and oncotic pressures and vascular physiology, eventually working our way back to:
Basic fluid dynamnics using an analogy with electronic circuits (with equations involving ohm’s law and everything), and why that’s clinically relevant in patients with hypertensive emergency (patient’s with increased afterload, or systemic vascular resistance.
Then I used this as a spring board to discuss the renin-angiotensin system, and how we can use this system to manipulate afterload using…
IV enalapril, a medication that rapidly decreases systemic vascular resistance, leading to the rapid relief of our patients symptoms, and stabilizing him for transport to the ICU.
Of course after that we talked about the more clinical medicine, but 100% of what I did for that patient was based thoroughly in a strong understanding of the basic sciences. You could argue all of that could be replaced by cook book medicine, consisting solely of checklists, but you’d be wrong.
By the way, evidence based medicine is NOT just a series of checklists, whoever suggested that a movement towards evidence based medicine means that medicine will require less knowledge of science is off base. I suggest you check out sciencebasedmedicine.org for the complexity and depth of understanding of science actually needed to practice evidence based medicine. If anything EBM is a movement that will require MORE and deeper science and math education for physicians.
Mind you, checklists are useful (I use them for a wide variety of procedures and guideline based therapies, but those are not the majority of medicine!)
I’m surprised that people think that you can just memorize everything and get by, there is too much in medicine to memorize. A decent depth of knowledge in the basic sciences and a dollop of seeing patients will get you further than memorizing a book.
For the tl;dr crowd: BS, medicine requires an actual depth of scientific knowledge and people hwo think otherwise appear not to have actually seen doctors from the other side of the chair (premed and preclinical med students are NOT doctors)
WcT, I wish there were more interactions like that in med school. Unfortunately, although most physicians at academic institutions are very knowledgeable in science and often encourage students to understand the underlying science behind patient care, most of what is tested in med school (and what you need to succeed in med school) is memorization (or at least pattern recognition – i.e., most board questions have buzz words that you have to memorize to know, few of them test any scientific concepts). This is coming from someone who’s been in med school for 8 years, not an armchair commenter (not a physician yet, but I know what med school administrators and national exams expect med students to know).
Q: Modern medicine would not exist as such with pharmaceuticals. Overall the modern pharmaceuticals cannot exist without hydrocarbons. Why is no one decrying the lack of geosciences involved in obtaining them?
A: Because that knowledge is not necessary for doctors to properly carry out the duties of their field.
Just because you’d like someone to know more about the thing you’ve spent years and years studying doesn’t mean they actually need that knowledge to properly function. And frankly, the horrendously difficult process that is currently used to create doctors is already long enough without scientists of every stripe clamoring that doctors absolutely positively need to learn my thing.
I hope a doctor understands Newton’s Laws well enough to realize that although net force=0 there can be many forces that add and subtract to equal 0, therefore creating homeostasis. High school (or sometimes college) physics teaching does not guarantee this.
I am all for physicians having some grasp of basic sciences and a hell of a solid grounding in biology and cellular chemistry. Just as I am all for psychologists having some grasp of basic sciences and a solid grounding neurobiology, attaching maybe a little less importance to cellular chemistry than physicians. It should also be impossible to become a physician (or psychologist, for that matter), without being capable of basic experimental design.
I believe rather firmly, that if you’re going to be mucking about with something, you should bloody well understand it and understand the processes that led to our fundamental understanding of it..
I also think that both fields should include engineering requirements – possibly in the place of non-med related basic sci requirements.
agm– Just because you’d like someone to know more about the thing you’ve spent years and years studying doesn’t mean they actually need that knowledge to properly function. And frankly, the horrendously difficult process that is currently used to create doctors is already long enough without scientists of every stripe clamoring that doctors absolutely positively need to learn my thing.
Exactly.
MDs are not PhDs.
As long as a French literature major can jump through all the necessary hoops just like a biochem major, why should I care? And why should I think a biochem major would be a better critical thinker, a better philosophical scientist than the French lit major?
Though I think scientists might think this is a problem because, as was stated above, physicians are probably the closest thing to a scientist Average Joes/Janes ever meet. We want them to be better ambassadors for us (not fair).
And then there is always the problem of a deluded, arrogant MD thinking they know as much as a PhD and making an ass of themselves (Oracs Creationist physicians, or my MD-prescribing-antiretrovirals-for-non-existent-retroviruses), so maybe more basic science would help them (or weed them out). But those are exceptions, not the norm… right?
I think it’s probably true that MDs in general do know as much as PhDs, if not more. But what they know is different – instead of spending four or six years researching deeply into one very specific kind of subject, they spend a roughly equal amount of time putting a huge breadth of information about a very large subject into their minds, and making a very functional mental framework for using that information. An MD is not just a lesser kind of graduate degree, it’s a beast of an entirely different nature, and talking about which of them is greater or lesser than the other is kind of silly.
I myself do not have any problem with a few students being admitted to medical school without the prerequisites everyone else has to take, as long as they are truly exceptional students who can pick up the necessary information in the “summer boot camp” and along the way. It doesn’t seem like a good path for most doctors, though.
I wouldn’t be so sure of that. For example, most med schools are pretty woo-friendly. Without a basic understanding of science, we’ll soon be seeing things like homeopathic MDs (diluting their drugs to make sure they really work well!).
There are a few distinct questions here:
1) Should doctors have some level of basic scientific training beyond the basic intro classes?
2) Should they be trained in basic science knowledge and scientific methods to the same level as a person who has written a thesis (M.S. or Ph.D.) on research?
The answer to the first question is an unqualified yes.
The answer to the second question is probably “no” unless they are planning to go into research.
What’s left is to explore the territory between “freshman-level chem and bio” and “M.S. thesis-level preparation in basic science knowledge and methods.” This gets us to our third question:
3) Should they be trained in each and every basic science field that has relevance to medicine?
The answer here is “probably not.” It’s nice in theory but probably impossible in practice.
That then takes us to Chad’s original question:
4) Given that aspiring doctors should study some amount of science above and beyond freshman chem and bio, should they take physics?
And my answer to that depends on what’s exactly on the menu:
-If intro physics in its current form is the only science course that involves very quantitative reasoning, well, they probably should take it. They might not use physics per se again, but spending some time on complex quantitative reasoning is probably valuable as part of their intellectual training.
-If the chemists have something intermediate between freshman chem and advanced P-chem, and they can teach it without a physics prerequisite, an argument might be made that this would be more relevant for them than a block of mass m on an inclined plane of angle theta etc. etc.
-If the physicists bother to learn enough biological context to teach from Benedek and Villars or something similar, then I’d give an unqualified “yes!” to the question of whether pre-meds should take physics.
I’ve been to some doctors whose education mostly seemed to be in classical languages. “Well, doctor, I have this patch of irritated skin.” “Does it itch?” “No.” “I see. Well, what you have there is apruritic dermatitis.”
Ping!
Having taught first year medical students lacking the basic sciences, and having worked alongside the medical profession for years on the research side, I can offer the following.
+ The training path in question has a range of endpoints, represented on the one hand by patient-intensive family and primary care practitioners, and on the other by medical researchers, as practiced by the physician-scholar (MD, PhD). Various specialized additional endpoints include:
= anesthesiology (includes physics and chemistry of organic gaseous agents and their interaction with aqueous biological systems),
= microbial and cancer chemotherapy (includes biophysical aspects of what it takes to get agents into these specialized “compartments”, and what it means to intersect and manipulate their complex biochemical systems),
= radiology [includes sophisticated interdisciplinary components: physics and engineering (imaging technologies), informatics (test data analysis), and bioorganic and bioinorganic chemistry (image agent function and interaction with biological systems and imaging technologies)],
= etc., etc., etc.
*Hence,* unless it were to evolve that there would to be different classes of physicians based on the sophistication of their career endpoint, the common path to train to these endpoints must include the *foundational* work to understand their most sophisticated technical aspects — not only of the current endpoints, but also of the anticipated.
+ The path toward these endpoints, with its strict limit in time to about four years — i.e., the basic medical degree, split between basic and clinical sciences — cannot for reasons of opportunity cost be burdened with interruptions to do remedial, “catch-up” studies. By way of example, if in first year, a medical student doesn’t already understand the college frosh/soph fundamentals of chemical equilibria and the relationship between chemical structure and pKa (and related chemical topics), the student will not have the basis to understand oxygen transport via hemoglobin, the physiology of ketoacidosis, the role of proton motive force in cellular energy transduction, or the balance of chemical and enzymatic processes at play during digestion and metabolism in the gut.
Learning in these areas would thereupon devolve to be simply rote, or must be remediated or simply set aside.
**To move students forward with added remedial asides in a defined period of study demands payment of opportunity cost — that other critical medical topics or practical training will simply not be learned as well. The cost of belated training in the fundamentals in medical school (not their forte) is that things at which medical schools are good at training — everything from physical examination and diagnosis to specifics from case studies, etc. — must get less time, at the very least in the student’s fixed schedule of learning.**
**To imagine moving students forward with rote or without any understanding of what is happening at the root of disease states and processes, and why things are happening … would be to relegate non-specialist physicians to the roles of script-following technicians. In medicine as in, say, computing/ telecommunications, such trainees would certainly be capable of addressing standard presenting symptoms (“cable modem is not properly connected”), but less so when the presenting issue is non-standard (“firmware is incompatible between modem and non-Windows wireless device, requiring identification of appropriate…”). That is to say, technical under-training pulls the rug from under the front-line physician, hampering their ability to consider critical subtleties in evaluating diagnostic evidence, in knowing when subtleties differentiate simple “take two aspirin” ailments from critical, life-threatening paralogs, etc.
Bottom line, if we want a medical profession characterized in largest part by rote-informed, script-following agents, one might imagine dispensing more broadly with requiring the college science foundations. Specialized training venues will certainly arise so that someone will be able to write their scripts (and likely to create a further class of intermediate specialists … to clean up the messes created by such a technocratic system).
On the other hand, if we want the “norm” to be evidence-based practitioners who will efficiently and effectively sort non-standard presenting situations from the standard (allowing necessary time and effort being spent where it is truly needed, and resulting in accurate diagnosis)… and if we want to create a context from which a next generation of research-capable physicians can arise to offer deep, new insights into health and disease … don’t dispense with the foundations, for goodness sake.
Better hone the teaching of the foundations, certainly — re-examine and focus traditional basic science training, add statistical and systems understandings to move reductionist understandings back toward reality — but do not dispense with them.
One opinion, from the near sidelines.
LeProf
Having taught first year medical students lacking the basic sciences, and having worked alongside the medical profession for years on the research side, I can offer the following.
+ The training path in question has a range of endpoints, represented on the one hand by patient-intensive family and primary care practitioners, and on the other by medical researchers, as practiced by the physician-scholar (MD, PhD). Various specialized additional endpoints include:
= anesthesiology (includes physics and chemistry of organic gaseous agents and their interaction with aqueous biological systems),
= microbial and cancer chemotherapy (includes biophysical aspects of what it takes to get agents into these specialized “compartments”, and what it means to intersect and manipulate their complex biochemical systems),
= radiology [includes sophisticated interdisciplinary components: physics and engineering (imaging technologies), informatics (test data analysis), and bioorganic and bioinorganic chemistry (image agent function and interaction with biological systems and imaging technologies)],
= etc., etc., etc.
*Hence,* unless it were to evolve that there would to be different classes of physicians based on the sophistication of their career endpoint, the common path to train to these endpoints must include the *foundational* work to understand their most sophisticated technical aspects — not only of the current endpoints, but also of the anticipated.
+ The path toward these endpoints, with its strict limit in time to about four years — i.e., the basic medical degree, split between basic and clinical sciences — cannot for reasons of opportunity cost be burdened with interruptions to do remedial, “catch-up” studies. By way of example, if in first year, a medical student doesn’t already understand the college frosh/soph fundamentals of chemical equilibria and the relationship between chemical structure and pKa (and related chemical topics), the student will not have the basis to understand oxygen transport via hemoglobin, the physiology of ketoacidosis, the role of proton motive force in cellular energy transduction, or the balance of chemical and enzymatic processes at play during digestion and metabolism in the gut.
Learning in these areas would thereupon devolve to be simply rote, or must be remediated or simply set aside.
**To move students forward with added remedial asides in a defined period of study demands payment of opportunity cost — that other critical medical topics or practical training will simply not be learned as well. The cost of belated training in the fundamentals in medical school (not their forte) is that things at which medical schools are good at training — everything from physical examination and diagnosis to specifics from case studies, etc. — must get less time, at the very least in the student’s fixed schedule of learning.**
**To imagine moving students forward with rote or without any understanding of what is happening at the root of disease states and processes, and why things are happening … would be to relegate non-specialist physicians to the roles of script-following technicians. In medicine as in, say, computing/ telecommunications, such trainees would certainly be capable of addressing standard presenting symptoms (“cable modem is not properly connected”), but less so when the presenting issue is non-standard (“firmware is incompatible between modem and non-Windows wireless device, requiring identification of appropriate…”). That is to say, technical under-training pulls the rug from under the front-line physician, hampering their ability to consider critical subtleties in evaluating diagnostic evidence, in knowing when subtleties differentiate simple “take two aspirin” ailments from critical, life-threatening paralogs, etc.
Bottom line, if we want a medical profession characterized in largest part by rote-informed, script-following agents, one might imagine dispensing more broadly with requiring the college science foundations. Specialized training venues will certainly arise so that someone will be able to write their scripts (and likely to create a further class of intermediate specialists … to clean up the messes created by such a technocratic system).
On the other hand, if we want the “norm” to be evidence-based practitioners who will efficiently and effectively sort non-standard presenting situations from the standard (allowing necessary time and effort being spent where it is truly needed, and resulting in accurate diagnosis)… and if we want to create a context from which a next generation of research-capable physicians can arise to offer deep, new insights into health and disease … don’t dispense with the foundations, for goodness sake.
Better hone the teaching of the foundations, certainly — re-examine and focus traditional basic science training, add statistical and systems understandings to move reductionist understandings back toward reality — but do not dispense with them.
One opinion, from the near sidelines.
LeProf
Crazy, doctors are scientists of the body, i don’t want my body scientists not knowing science. Is the lesson NOT to go to a Dr from Mount Sinai??
Crazy, doctors are scientists of the body, i don’t want my body scientists not knowing science. Is the lesson NOT to go to a Dr from Mount Sinai??
Q: Why do pre-meds have to take Physics?
A: To weed out the dumb ones that would otherwise become doctors and kill people.
😀
Certain colleges are proud of their rates of weeding out idiots from pre-med with classes like this. Who knows, maybe in the future everyone will be allowed to become a dr b/c you don’t want to hurt anyone’s feelings by saying they are not a good enough student to be a doctor.
I don’t like the idea that Pre Med Courses are “weed out” courses, I mean Medicine is a multi branch area of science. There are many areas in Medicine that require Chemistry, some require Physics and each of these needs to be used in tandem to work out how the body reacts to said properties of science, whether it is the effects of UV on a burn victim for when they leave the burns unit or the recovery time of a child’s stomach who has drank a mouthful of drain cleaner. If the doctor in charge of these cases struggled with Physics at Pre Med and so never took Physics that doctor will still be struggling at Physics as a fully qualified doctor hence putting patients at risk. The same goes for Chemistry. It isn’t about weeding out the less able doctors but making all doctors more rounded scientists because after all Medicine is a science, even if it isn’t as conventional as the pure subjects. It should be a requirement of all doctors to want to do everything for their patients whether they are ones they have seen many times before or ones they won’t see for another 20 years waiting in the pipelines and if that means they have to suck it up and take some courses that may be challenging then so be it. I don’t want a doctor that can name all the bones in the human body, I want one that can treat all the bones in the human body for anything that might be wrong with them be it Chemical, Physical or Biological.
A med student sitting in physics class interrupts his professor while he gives a lecture. He says “how does learning this save lives?”. The professor looks at him for a second, turns around, and continues his lecture. About two minutes later the student once again interrupts the lecture, and says “I still don’t see how learning this saves lives!”. The professor once again pauses for a moment, then continues on. Minutes later the med student, almost yelling, says “HOW DOES THIS SAVE LIVES?!!” The professor looked at him for about ten seconds, then finally replies: “It saves lives because it keeps certain people out of Medical school!”
A med student sitting in physics class interrupts his professor while he gives a lecture. He says “how does learning this save lives?”. The professor looks at him for a second, turns around, and continues his lecture. About two minutes later the student once again interrupts the lecture, and says “I still don’t see how learning this saves lives!”. The professor once again pauses for a moment, then continues on. Minutes later the med student, almost yelling, says “HOW DOES THIS SAVE LIVES?!!” The professor looked at him for about ten seconds, then finally replies: “It saves lives because it keeps certain people out of Medical school!”