Making med school easier to swallow

In 1982, 3924 college seniors applied to Harvard Medical School. Only 166 were accepted, fewer than 150 from schools other than Harvard College. That statistic hardly contradicts the legend about undergraduate pre-medical education, a legend which includes 9 a.m. organic chemistry classes and students fighting to change their grade from an "A," to an "A"--and that of their classmates from a "B+" to a "B."

The legend is sensationalist, but it contains a kernel of truth. And the mere presence of such a legend indicates, administrators say, that the pressure on pre-medical students is too intense. "For many students, especially sophomore year when they're taking organic chemistry, it [a pre-medical education] is bell," says Professor of Biology and Associate Dean of the Faculty John E. Dowling '57.

Realizing that because pre-medical worries focus disproportionately on the five full-year courses required for medical school admissions, several members of the College and Medical School faculty, in tandem with a group of College administrators, have been working informally for the past year to develop a uniform strategy for easing the pressure. The group includes Dowling, Dr. Daniel D. Federman and Dr. James Edelstein, both of the Medical School, and Associate Dean of Undergraduate Education Sidney Verba '53.

Medical school requirements are an undesireable intrusion on the college curriculum and should therefore be kept to a bare minimum," wrote President Bok in his 1982-83 President's Report. This year's report was devoted to an examination of medical education, both graduate and undergraduate, and is credited by many for the formation of the informal pre-medical education group.

The report criticizes the tendency to sacrifice communities courses to fulfill admissions requirements." "Educators have long observed that pre-medical requirements and prevailing admissions others push college students into majoring in science and stir anxieties that distort the course election and ever, the extracurricular activities of many undergraduates," Bok continues.

Most medical schools currently require at least one year of physics, one year of inorganic and one year of organic chemistry, one year of biology, one year of mathematics--usually calculus--and a year of English.

"We don't want to assume that everyone's going to take a single magical cluster of courses," Federman says. "We want to develop new courses to, is a sense, get around the Chem 20 bottleneck," says Verba.

The Harvard group cites three major areas as problems for pre-medical students. First, as Verba says, "With requirements in the Core, concentration and pre-medical requirements future med students are left with as little as four electives." To ease the burden, pre-meds frequently major in a science field, combining medical school and department requirements and maximizing electives. "We want to make it possible for students to major in any field they want and still attend medical school," Federman says.

Second the courses that pre-medical students are required to take now stress research rather than healing skills, to the detriment of future physicians, in the opinion of many in the informal group. Group members stress the difference between medical and scientific knowledge, saying that advanced science may not be relevant to what a doctor should know.

"At the moment, people with interests in advanced science and advanced medicine seem to be taking the same courses. They're not the same thing, precisely," says Federman.

"If you look at what's being taught, I think the content of these courses is really less and less relevant to a pre-med. We teach science on the cutting edge," Dowling says.

"The problem is that undergraduates come to med school with too much science and not enough science: they're not well rounded enough, but much of the science they have learned is not relevant," Verba says.

Finally, some of those involved with pre-medical education are dismayed by the seeming lack of cohesion among required courses. "Pre-medical courses as presently organized aren't integrated, nor are they structured to medicine," Dowling says. "You begin with biology in the first year and end with physics, when that [physics] is really the basic, it should be the other way around," he adds.

One possible solution to these problems that is currently under consideration is an integrated series of two year-long courses that would be open in the first year to non-premedical students and would provide complete eligibility for medical school admission after completion of the second year. The courses would combine elements of each full-year course currently required for medical school admissions but would focus the student's attention on medical, rather than purely scientific, applications. If the year-long courses could be integrated into the Core curriculum, its proponents argue, pre-medical students would be free to major in non-science fields and comfortably complete medical school requirements. The plan was first outlined in Bok's report.

"Such students would have fewer facts, there's no question about that," Dowling says, "but they might be better doctors."

The two-year proposal, still in the formative stages, has already won widespread praise from medical schools across the country, according to Federman. Dean for Students and Alumni at the Medical School, Federman has approached the directors of a number of schools in recent months about the plan. "The reaction for some sort of change in the current system of pre-med education was overwhelming," he says.

"In principle, I would be all for it. I think there's a tremendous need for a greater breadth in medical education," says Raymond B. Clayton, director of admissions at the Stanford Medical School. "I'd like to explore the possibility of putting together courses that one might designate as 'life science' courses," he adds.

The positive reaction to change is a vital step in any reform of either national or local standards of pre-medical education. Ultimately, any changes are dependent on what graduate schools deem acceptable. "We as an undergraduate school can design any courses that we want for pre-meds. The question is that the graduate schools don't necessarily have to accept that," Verba says.

Educators note, however, that although admissions to top medical schools remain stunningly competitive, medical school applications overall are at a five year low. "This is a good time to try change," Federman says.

Students at Harvard are divided on the wisdom of pre-medical reform efforts. Many students, particularly those who voluntarily major in scientific fields, say they enjoy the research-oriented nature of pre-medical courses. "I've liked the approach they took that you weren't just being prepared for the MCATS or medical school. They [pre-medical courses] were real science courses," says Elaine T. Anderson '84. "I think almost everything you're doing in your pre-med courses will pop up again in your first year of med school," says Lenny Ganz '84. Both Anderson and Ganz majored in Biology. Both will attend Harvard Medical School.

Other students agree with Bok that the existing system is overly constricting and interferes with the ability of students to obtain a broad, liberal arts education. "I think they [medical school graduates] will be great researchers, but I don't think they know what medicine is about," says Gabriela Feuria '84. Feuria majored in Biochemistry.

Harvard's counseling services appear to be attempting to practice what the administration preaches. The Office of Career Service's "Guide For Pre-Medical Students" stresses that medical schools "do not require that applicants major in science." Extensive counseling services are available in each House. While the advising systems differ in structure (some Houses utilize pre-medical committees, others rely on individual advisors for students, for example) students say they are generally efficient and satisfactory--their message that a non-science major is acceptable is clear. "Medical schools, it seems really don't care whether you major in science or not," Ganz says. Completing requirements and winning acceptance to a top school is left to the students.