Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century After the Flexner Report

Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century... By Donald A. Barr 240 pp, $50 Baltimore, MD, Johns Hopkins University Press, 2010 ISBN-13: 978-0-8018-9416-9 What is the purpose of undergraduate premedical studies? How can this purpose best be achieved? These deceptively simple questions have been the focus of ongoing and often heated debate for more than a century within the medical and the educational establishments. In Questioning the Premedical Paradigm, Donald Barr, associate professor of medicine and sociology at Stanford University, explains why the standard premedical curriculum is so heavily weighted toward the basic sciences; investigates whether or not this has, in fact, achieved what was intended; examines some of the unintended consequences resulting from its adoption; and cogently presents what he feels the goals of premedical education ought to be and how they can be reached. It is often held that successful completion of the traditional premedical curriculum, with its emphasis on the physical sciences, identifies those students most likely to graduate from medical school, thus minimizing drop-out rates. Victor C. Vaughn, former president of the American Medical Association, declared in 1914 that “no man is fit to study medicine unless he is acquainted, and pretty thoroughly acquainted, with the fundamental facts in physical, chemical, and biological subjects.” However, as this book points out, studies have repeatedly failed to find a correlation between science grade point average (GPA) and Medical College Admission Test (MCAT) scores and higher medical school graduation rates. It also is often held that a mastery of the physical sciences is necessary to become a good clinician. Abraham Flexner, whose influence on medical education in the United States remains strong a century after the publication of his eponymous report, stated that “the normal rhythm of physiologic function must remain a riddle to students who cannot think and speak in biological, chemical and physical language.” While Flexner and others successfully argued in favor of adopting a corpus of study—which became the de facto standard for undergraduate premedical education—focused predominantly on these subjects, others felt differently. Hugh Cabot, dean of the University of Michigan Medical School, wrote in the Bulletin of the Association of American Medical Colleges in 1926 that I am not prepared to admit at the present time that in the equipment of the practitioner a knowledge of science is of more real value than a knowledge of the way in which mankind has behaved in the past and how he is on the whole behaving at the present time. The problems of medicine, on the whole, are quite as likely to require sound judgment based upon a knowledge of history, sociology, philosophy and psychology as on the facts of science. The evidence Barr presents is more supportive of Cabot than Flexner. GPA and MCAT scores have not been shown to predict clinical competence; if anything, they have been shown to negatively correlate with empathy and sensitivity, both of which are essential for the practice of medicine. One study comparing GPA and MCAT scores with psychological testing of medical students at the University of California, San Francisco, during a 12-year period found that students with higher grades in the sciences were “narrower in interests, less adaptable, less articulate, and less comfortable in interpersonal relationships than their lower scoring peers.” If the traditional premedical curriculum does not produce better medical students or physicians, what does it do? One of its unintended consequences is to discourage underrepresented minority students from pursuing medicine as a career. Barr presents data showing that premedical chemistry courses are one of the main reasons underrepresented minority students decide to abandon pursuing a career in medicine. This abandonment has resulted in reduced physician diversity and has had pronounced effects on the physician workforce, because underrepresented minority physicians are statistically more likely to practice primary care medicine and to work with indigent and minority populations. One important role that a solid science-based education provides, and that Barr does not address, is that of enabling the development of physician-scientists, who play a critical role in academic medicine and have been responsible for many of the most significant medical discoveries of the last century. Although his proposal of teaching basic science within a paradigm of “context based teaching” would shorten the amount of time dedicated to these subjects and free more time for the study of the humanities, one cannot help but worry that this could leave the physicians of tomorrow ill-equipped to further advance both the science and practice of medicine. Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion and framing it to allow the current model of premedical education to be rethought in a way that will conform to the needs of the profession and to the needs of society as a whole. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Rosen reported receiving payment for lectures, including service on speakers bureaus, for CME courses related to Perspectives in Pediatrics conferences, Miami Children's Hospital, Harvard Medical School, and PriMed. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century After the Flexner Report

Rosen, Dennis
JAMA , Volume 306 (9) – Sep 7, 2011
Download PDF
1 page

Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century After the Flexner Report

Abstract

By Donald A. Barr 240 pp, $50 Baltimore, MD, Johns Hopkins University Press, 2010 ISBN-13: 978-0-8018-9416-9 What is the purpose of undergraduate premedical studies? How can this purpose best be achieved? These deceptively simple questions have been the focus of ongoing and often heated debate for more than a century within the medical and the educational establishments. In Questioning the Premedical Paradigm, Donald Barr, associate professor of medicine and sociology at Stanford University,...
Loading next page...
 
/lp/american-medical-association/questioning-the-premedical-paradigm-enhancing-diversity-in-the-medical-ncRSKySke6

References (0)

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2011.1267
Publisher site
See Article on Publisher Site

Abstract

By Donald A. Barr 240 pp, $50 Baltimore, MD, Johns Hopkins University Press, 2010 ISBN-13: 978-0-8018-9416-9 What is the purpose of undergraduate premedical studies? How can this purpose best be achieved? These deceptively simple questions have been the focus of ongoing and often heated debate for more than a century within the medical and the educational establishments. In Questioning the Premedical Paradigm, Donald Barr, associate professor of medicine and sociology at Stanford University, explains why the standard premedical curriculum is so heavily weighted toward the basic sciences; investigates whether or not this has, in fact, achieved what was intended; examines some of the unintended consequences resulting from its adoption; and cogently presents what he feels the goals of premedical education ought to be and how they can be reached. It is often held that successful completion of the traditional premedical curriculum, with its emphasis on the physical sciences, identifies those students most likely to graduate from medical school, thus minimizing drop-out rates. Victor C. Vaughn, former president of the American Medical Association, declared in 1914 that “no man is fit to study medicine unless he is acquainted, and pretty thoroughly acquainted, with the fundamental facts in physical, chemical, and biological subjects.” However, as this book points out, studies have repeatedly failed to find a correlation between science grade point average (GPA) and Medical College Admission Test (MCAT) scores and higher medical school graduation rates. It also is often held that a mastery of the physical sciences is necessary to become a good clinician. Abraham Flexner, whose influence on medical education in the United States remains strong a century after the publication of his eponymous report, stated that “the normal rhythm of physiologic function must remain a riddle to students who cannot think and speak in biological, chemical and physical language.” While Flexner and others successfully argued in favor of adopting a corpus of study—which became the de facto standard for undergraduate premedical education—focused predominantly on these subjects, others felt differently. Hugh Cabot, dean of the University of Michigan Medical School, wrote in the Bulletin of the Association of American Medical Colleges in 1926 that I am not prepared to admit at the present time that in the equipment of the practitioner a knowledge of science is of more real value than a knowledge of the way in which mankind has behaved in the past and how he is on the whole behaving at the present time. The problems of medicine, on the whole, are quite as likely to require sound judgment based upon a knowledge of history, sociology, philosophy and psychology as on the facts of science. The evidence Barr presents is more supportive of Cabot than Flexner. GPA and MCAT scores have not been shown to predict clinical competence; if anything, they have been shown to negatively correlate with empathy and sensitivity, both of which are essential for the practice of medicine. One study comparing GPA and MCAT scores with psychological testing of medical students at the University of California, San Francisco, during a 12-year period found that students with higher grades in the sciences were “narrower in interests, less adaptable, less articulate, and less comfortable in interpersonal relationships than their lower scoring peers.” If the traditional premedical curriculum does not produce better medical students or physicians, what does it do? One of its unintended consequences is to discourage underrepresented minority students from pursuing medicine as a career. Barr presents data showing that premedical chemistry courses are one of the main reasons underrepresented minority students decide to abandon pursuing a career in medicine. This abandonment has resulted in reduced physician diversity and has had pronounced effects on the physician workforce, because underrepresented minority physicians are statistically more likely to practice primary care medicine and to work with indigent and minority populations. One important role that a solid science-based education provides, and that Barr does not address, is that of enabling the development of physician-scientists, who play a critical role in academic medicine and have been responsible for many of the most significant medical discoveries of the last century. Although his proposal of teaching basic science within a paradigm of “context based teaching” would shorten the amount of time dedicated to these subjects and free more time for the study of the humanities, one cannot help but worry that this could leave the physicians of tomorrow ill-equipped to further advance both the science and practice of medicine. Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion and framing it to allow the current model of premedical education to be rethought in a way that will conform to the needs of the profession and to the needs of society as a whole. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Rosen reported receiving payment for lectures, including service on speakers bureaus, for CME courses related to Perspectives in Pediatrics conferences, Miami Children's Hospital, Harvard Medical School, and PriMed.

Journal

JAMA – American Medical Association

Published: Sep 7, 2011

There are no references for this article.