Article Review: Rethinking the premed requirements

Think back to your college years. Remember those premed courses that you had to take? Biology, chemistry, physics... oh my. How helpful were these in your preparation for medical school and clinical practice?

In 1981, the Association of American Medical Colleges assembled a group, the General Professional Education of the Physician and College Preparation for Medicine (GPEP) to relook at these premed requirements. In 1984, the published a report "Physicians for the Twenty-First Century". They advocated that the intensive premed requirements overly skews students' education towards a "narrow objective of medical school admission". Education is not balanced to include broader liberal arts learning, which may teach students more about humanistic values and communication skills.

Despite these recommendations, not much has changed. Medical schools are still using high MCAT scores (which test the premed requirements) to determine admission.

Actually this is only mostly true. Mount Sinai medical school established a Humanities and Medicine Program (HuMed) in 1987. Innovatively, the school offers college sophomores and juniors majoring in the humanities or social sciences a GUARANTEED medical school spot upon completion of college.

Admission does not require the traditional premed requirements, except just only 1 semester each of biology and general chemistry. Nor does it require taking the MCAT. Admission requirements only include 2 essays, SAT scores, 2 interviews at Mount Sinai, and a minimum GPA of 3.5 throughout college.

Interestingly, accepted HuMed students are required to attend a 8-week summer program at Mount Sinai after junior year to get a crash course in Medicine. This includes clinical exposure in various specialties and an intensive introduction to chemistry and physics -- as they related to medicine.

Furthermore, in the summer before matriculation, Mount Sinai offers a Summer Enrichment Program (SEP) to help HuMed students to get acclimated to the medical school learning environment and upcoming curriculum. About 75% of the HuMed students participate in this. The curriculum covers the biochemistry, anatomy, embryology, cell physiology, and histology.

This publication reports the outcomes of the HuMed students (n=85) during 2004-2009 as compared to the traditional, non-HuMed students (n=606) during that same time. In other words, are the traditional premed requirements necessary to ensure success in medical school and beyond?

Results

Interestingly, there were no differences found in the following outcome measures:

• USMLE Step 1 failure rate
• Honors grades in clinical clerkships (In fact, 46% HuMed students got honors in Psychiatry compared to 23% for non-HuMed students)
• AOA distinction
• Rank in the top 25% of the class
• Medical Student Performance Evaluation (a.k.a. Dean's Letter) final descriptors

Also, HuMed students were more likely to:

• Dedicate a year to scholarly research (28.2% vs 14.1% non-HuMed students)
• Pursue a career choice in primary care and psychiatry

On the flip side, HuMed students were also more likely to:

• Have a slightly lower USMLE score (221±20 vs 227±19 non-HuMed students)
• Take a leave of absence because of personal, academic, or psychiatric difficulties (11% vs 3% for non-HuMed students)

Quoting the authors, they hypothesize that HuMed students gain a lot from their more broad liberal arts college education:

• Enhanced communication skills and a more humanistic approach to the patient, as evidenced by HuMed students’ better performance in psychiatry
• Greater interest in pursuing broader medical school experiences, as evidenced by HuMed students’ greater participation in scholarship and research"
• A heightened interest in fields that provide greater interpersonal connections between patient and physician, as evidenced by HuMed students’ trend toward residencies in primary care and psychiatry.

The Mount Sinai program really challenges the concept of the traditional premed requirements and MCAT examination. It is time to rethink why the premed requirements are there.

Thanks to Fred Wu for letting me know about this publication.

Reference

Muller D, & Kase N (2010). Challenging traditional premedical requirements as predictors of success in medical school: the Mount Sinai School of Medicine Humanities and Medicine Program. Academic medicine : journal of the Association of American Medical Colleges, 85 (8), 1378-83 PMID: 20671464

-