The Future Doctor's Friend

(Premed Advisor and Assistant Senior Tutor in Adams House.)

WHAT THEY don't tell you when you arrive as a freshman premed is what courses to take. And by sophomore year there are more disillusioned ex-premeds than there need be. Furthermore, because of wrecked hopes and poor spirits, these otherwise superb people are a shambles. Why? Because they have taken the wrong premed courses, they have done poorly, and they then doubt their own abilities and their own genuine desires to become "doctors."

The point of writing this article is two-fold: (1) to help freshmen select the appropriate premed courses before it is too late, and (2) to draw attention to the lack of information provided by all the various science departments and to the lack of premed advising in the Yard and for freshmen in general.

What are the premedical requirements?

The requirements for admission to medical school include one year of biology with lab, two years of chemistry with lab, one year of physics with lab, and one year of mathematics. In general, AP courses taken in secondary school may not be counted; most states require the five premedical courses in college before licenses to practice medicine can be issued. Don't plan on anything less than five years of science and math as listed above. Furthermore, medical schools are unhappy with just the minimum requirements; but that is something to worry about later. The premedical requirements should be completed by the end of junior year, and only under exceptional circumstances (such as a late decision to study medicine) this should be the case.

SO WHAT?

Everybody knows that a year each of biology, physics and math, and two years of chemistry are required. What they do not understand is the order in which to take the premed courses. Not only do students fail to understand the importance of the "holy order," but, apparently, most of the involved departments are so parochial as to ignore the issue. The priorities for enrollment in prerequisite premedical courses should be mathematics, chemistry, biology, and physics in that order.

For heaven's sake, get a good grounding in mathematics before ever going on even to Nat Sci 3. The appropriate math to take ranges from Math Ar to Math 21. The math requirement is the most flexible of all the premed requirements as far as the medical schools are concerned. The med schools are often willing to accept pre-calculus, statistics, computer sciences, etc. to fulfill the requirement. Clearly, if you are a student with excellent math preparation, say an AP score of 4 or 5, you need have little concern except that you must still take Math 20 or, preferably Math 21. Otherwise, enroll in either Math Ar or Math 1a.

A word about Math Ar. This course was designed to fill a gap which the Math Department denied existed until the inception of the course. Math Ar prepares students for calculus and prepares students for sciences that require facility in algebra, trig, etc. As far as medical schools are concerned, with very rare exceptions among those schools requiring calculus per se, Math Ar is sufficient to fulfill half of the premed math requirement. As a course, it has status with any other; it is offered for credit; and it is perhaps more conscientiously taught than other math courses. Students are sometimes worried that taking Math Ar will delay their progress. However, they should realize that nothing will impede their chances of doing well in the sciences as much as not knowing the material in Math Ar.

A reasonable, recommended beginning program for freshmen with little AP exposure in math or chemistry is Nat Sci 3 and Math 1 or Math Ar. More than two premedical courses as a freshman is unwise unless you are not only confident about your academic prowess in the sciences, but also have demonstrated facility in sciences. Such demonstrated facility would include previous excellent work in secondary school in chemistry, physics, mathematics; APs in chemistry, physics, math or biology; or, superhigh math SAT scores (over 700-750) with considerable exposure to the sciences in secondary school.

THE FUNDAMENTAL principle.

The fundamental principle to be kept in mind in selecting premed courses as a freshman is it is always safer to enroll in easier courses as a freshman and then move up to the more difficult ones as a sophomore and beyond. (note: this is contrary to the advice given by most science departments). Perhaps the most important single factor determining whether a freshman goes on to be "premed" or drops the idea is his performance in premedical courses as a freshman. All too often students enter their sophomore years with poor grades in two or three difficult (or not so difficult) science courses and decide that because of these poor grades earned during their freshman year, they should not go on. To avoid such discouragements, which often snowball into a disastrous sophomore slump, you should avoid a rough science schedule with inadequate math background as a freshman. If you fear a rough time with chemistry or biology as a freshman, take only Math Ar and Math 1a or Math 1a and 1b and plan to take Nat Sci 3 as a sophomore. And if you find chemistry hard you may well need to strengthen your math background and should consider Math Ar. The worst of all possible worlds is when a freshman loses all his self-confidence. Freshman year is a rough time of adjustment, self-doubt, etc.; and work in the sciences is best deferred until a rough period of adjustment has passed.

MATH.

Math Ar and Math 1a together are a good pair for the medical school premed requirement and for preparation for Nat Sci 3 or other chemistry courses. Realize that Math 1a (also Math 21a) is offered in the Spring as well as the Fall, and that Math 1b is offered during both semesters as well, making it possible to take Math Ar, Math 1a and 1b in sequences beginning with the fall semester of freshman year. If you feel your background in math is good, take Math 1 straight off. If you have less than 600 on the math SATs, or did not have a full algebra II and trigonometry course in high school, you should consider Math Ar. AP in the AB Math AP exam leads most appropriately to Math 1b, which should be taken straight off at the beginning of freshman year; and BC Math AP leads most appropriately to Math 20 or 21. Math 21 is less applied and more theoretical than Math 20; both are fine choices. Statistics and Nat Sci 110 may be counted for the math requirement at many medical schools, but this should be cleared at each medical school and the fact that you are using either of these to fulfil the premed math requirement must be stated in your medical school applications and letters of recommendation from your House.

N.B.: Nat Sci 1 a is not intended to be useful in providing a background for further math courses nor for competence in calculations necessary for science courses; it should not be taken to fulfil premed requirements.

CHEMISTRY.

Chemistry, after math, is the most logical starting place for premeds for several reasons:

(1) The chemistry sequence is two or more years long and should be completed by the beginning of senior year;

(2) Bio 2 and Nat Sci 5 as well, require familiarity with chemistry;

(3) Many advanced biology courses require or recommend chemistry courses; and,

(4) Since Chem 20 is the Waterloo of so many premeds, (and, since it promises to be the Waterloo of many more premeds since the recent prerequisites have been added), it is best to prepare for Chem 20 early along in college and avoid leaving it for the senior year.

Fallacies in thinking have led to the conclusion of both the Biology Department and those professors teaching Chem 20, that Chem 6 is better preparation for Chem 20 than Nat Sci 3 with either Chem 40a or, now, Chem 5. Thus, a recent flyer entitled "Information for Freshmen Considering Concentration in Biology" states:

...WHAT TO TAKE YOUR FRESHMAN YEAR...

3). If you are qualified to take Chem 6, you should do so. Statistics have shown that it is substantially better preparation for Chem 20.

And, at the initial meeting of Chem 20, Professor Doering stated that one in four students who fail to have the prerequisites as listed in the catalogue under Chem 20 (i.e., an A or A-in Nat Sci 3, an average of B-or better in Nat Sci 3 and Chem 40a, or a C or better in one semester of Chem 6) will earn a grade below C-in Chem 20 on the basis of previous years' data.

OBVIOUSLY, more capable science students and those students with stronger science backgrounds elect the more difficult science courses (i.e., Chem 6). Thus, it is not surprising that those students who have taken Nat Sci 3 do less well in Chem 20 than others. While one-fourth of those lacking the stated prerequisite for Chem 20 do lower than C-work in the course, it would be helpful to know first how that compares with other students enrolled in the course, and second, how well the other three-fourths of students without the prerequisites do. It would be especially interesting to know whether other factors, for example, SAT scores in Math, explain Chem 20 performance.

The real issue, it seems to me, is a moral one. While I entirely sympathize with the professors teaching Chem 20 about the need for better preparation before doing Chem 20, I do not agree with a set of prerequisites that may preclude certain students from enrolling. According to yesterday's Crimson, "the prerequisites for Chem 20 have been overhauled, presumably to reduce the unmanageable size of the course."

As a premedical advisor, I might tell a senior applying to a certain medical school that I fear he will be rejected or that he has a very slim (or virtually no) chance of being admitted; I could not tell that same student not to apply. Similarly, I can explain to a student that he has a poor chance of doing well, but I cannot tell him not to enroll in a course that is required for concentration in both Biology and Biochemistry and that is required for application to medical schools. Some students were frightened away from the first session of Chem 20 because of the prerequisites as listed in the catalogue, and many were phenomenally discouraged after the first meeting because of the tone set by Professor Doering. It is in no way consoling to hear, as stated in the Crimson yesterday, that

...due to the abruptness of the prerequisite policy change, students who have been adversely affected by the new requirements may find it easier than ever to talk themselves into the course...

Because of the prerequisites, some students will be greatly inconvenienced in having to rearrange their schedules--schedules that are often planned two to three years in advance. Perhaps some students will fail to enroll in Chem 20 at a time that would optimize their chances at gaining admission to medical school. I must agree with the Chem 20 instructors that good performance in Chem 20 is desired outcome. However, to suggest that performance in Nat Sci 3 or Chem 6 is a good indicator of projected performance in an organic chemistry course ignores both the initial factors determining who takes which introductory chemistry sequence and the backgrounds and aptitudes of those various students. While individual cases may have been leniently considered this year, permitting most students interested to enroll in Chem 20, the attitude of the teachers is somewhat disheartening. It is known that the need to teach Chem 20 is regarded as a "chore" and probably is resented by those chemistry faculty who see premeds as a drain on their time. This was reflected in what I felt was a harsh tone in the initial class of Chem 20. All of the students failing to meet the prerequisites as stated in the catalogue were called together in a single room, and thereby, rather inappropriately I feel, singled out during the last 20 minutes of the class. Certainly the increasing enrollment in Chem 20 is a problem of large dimensions that needs solutions; such solutions might include two levels of Chem 20 or a condensed double course offered in one semester, such as those offered in the languages.

FRESHMEN are advised to follow carefully the placement recommendations for the various introductory chemistry sequences. Thus, if one has AP credit, either Chem 5 or Chem 20 is appropriate. The bulk of students do not have advanced placement, however, and should elect either Nat Sci 3 followed by Chem 5 or Chemistry 6, Despite the recommendations of the Biology Department and the implicit recommendation of the Chem 20 prerequisites, Chem 6 should be elected only by students with superb math aptitude and science capacity. Chem 40a may fulfil the second half of the initial year chemistry requirement; however, Chem 40a is simply not recommended by me for the following reasons: it focuses primarily on tedious calculations and its lab is useful primarily in making anal compulsives out of premedical students who are already too far developed along those lines. Most importantly, the techniques learned simply are not terribly relevant to anything done in medical school courses.

It is almost always wiser to enroll in an easier course as a freshman and do well, and then move up to the more difficult ones as a sophomore and beyond. While a good (B-, B) grade in a difficult course (e.g., Chem 6) is perhaps equivalent in the eyes of informed medical school admissions committees to an excellent (A-, A) grade in an easier course (e.g., Nat Sci 3), a very poor (C-, C) grade in any course of non-Herculean difficulty is a bad thing.

In sum, as a freshman, enroll in Nat Sci 3 and either Math 1 a or Math Ar unless you have been recommended for placement in other courses on the basis of placement scores.

BIOLOGY.

The choice between Nat Sci 5, which has recently been upgraded, and Bio 1 and 2 is a difficult one. Perhaps one way of determining which to take can be based on background; clearly, an AP in Bio places you out of the ball park and into between-level courses (Bio 10 thru 99). If you have had strong high school biology and are competent in the chemical sciences as well as math, Bio 1 and 2 seem most appropriate.

If you are not intending concentrating in Biology and you have strong background in the sciences, I would suggest fulfilling the premed requirement in biology with Bio 2 and any one of the between level courses with lab rather than with Bio 1 and 2. Bio 1 simply is not terribly relevant nor terribly helpful for medical school work. Thus, Bio 15a, Bio 10b, or Bio 21 are reasonable adjuncts to Bio 2. Biology should be deferred until sophomore year for two reasons: performance as a freshman in chem and math can give you a clue about which biology to enroll in (between Nat Sci 5 and Bio 2); and, unless you are intending to major in Biology, there is no rush to have a large number of biology courses. Most of the advanced bio courses require Chem 20, and so it behooves you to take the chemistry courses first, saving biology for sophomore year and beyond.

One reasonable way to take biology as a freshman, especially if you have a burning desire to do biology then, is to take chemistry (either Nat Sci 3 or Chem 6) in the first semester and, if you manage to do honors work in both the chemistry and math courses first semester, enroll in Bio 2 during the spring, in general, however, it is probably wise to defer your initial bio course until sophomore year. After having taken the one-year of required biology, it is wise to take at least an additional semester of bio, which might include any of the between-level courses or Biochem 10, which, I feel, is a superb choice.

PHYSICS.

Physics should be deferred until adequate mathematics preparation has been obtained. Thus, Physics 1 is most appropriately taken after completion of Math 1, although it may be taken after only Math 1a, if Math 1b is taken concurrently. Frankly, the physics requirement is perhaps the least important to the medical schools, and if any course if left to the senior year or to the summer-school session before senior year, it should be physics.

Nat Sci 2 or Nat Sci 7 may be taken to fulfill1