Med school finds nonscience background doesn't hinder students
■ Applicants accepted to Mount Sinai's program in New York without traditional prerequisites perform on par with their peers, a study finds.
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A century ago, educator and scholar Abraham Flexner laid the groundwork for standard medical education, including what prospective physicians should know before they set foot in a medical school classroom.
Today, most medical schools require applicants to have two semesters each of biology, inorganic chemistry and physics, plus one or two semesters of organic chemistry. Despite periodic debate, those standards have changed little among U.S. medical schools in the decades since Flexner's report.
Mount Sinai School of Medicine in New York tried something different.
In 1987, the school created the Humanities and Medicine program -- HuMed for short -- to accept humanities or social science majors as undergraduate sophomores and juniors. Students are guaranteed medical school admission if they meet certain requirements, including maintaining a 3.5 grade-point average. They don't have to take organic chemistry, physics, calculus or the Medical College Admission Test.
A new study shows these students performed on par with classmates who met traditional admission requirements. They also were more likely to dedicate a year to research and graduate with distinction in research, according to the study in the August Academic Medicine.
"Of course, they come in at a disadvantage. Despite that perceived disadvantage, it is certainly possible to catch up," said David Muller, MD, study co-author and associate professor and dean of medical education at Mount Sinai. "These students can go on to be presumably very successful."
About two in three students in the program sought residency training in primary care (49.4%) or psychiatry (14%), the study showed. By comparison, 39% of their peers chose a primary care residency and 5.6% selected a psychiatry residency.
Mount Sinai researchers evaluated 85 HuMed participants compared with 606 traditional students from 2004 to 2009. They found little difference in students' performance. The two groups performed equally well on most measures, such as commencement and clerkship honors.
Students in the HuMed program scored slightly lower on the U.S. Medical Licensing Examination Step 1.
After their junior year in undergraduate work, HuMed students must attend an eight-week summer program at Mount Sinai. They do clinical service rotations, attend seminars and take a course on the principles of organic chemistry and physics. About 75% return for a voluntary preparatory session before starting medical school. The attrition rate after the first summer session ranges from 5% to 10%.
Though they may struggle initially, these students quickly catch up to their medical school peers. The same is true for other humanities majors who go to medical school, said Henry Sondheimer, MD, senior director for student affairs and student programs for the Assn. of American Medical Colleges.
"Medical schools realize that the transition to the preclinical years is frequently more stressful for people who were not chemistry or biochemistry majors," said Dr. Sondheimer, who majored in English as an undergraduate. "Those people who are very committed to medicine come up to speed relatively quickly."
Nationwide, about 30% of medical students do not take a traditional premedicine path.
As an undergraduate adviser, J. Scott Wright, EdD, said he encourages students to "broaden their horizons and get more humanities." That can be a hard sell for premed students, who are more focused on getting the credits and grades they need to be competitive for medical school, said Wright, associate dean of undergraduate education at the University of Texas at Dallas.
"Medical schools in general have been encouraging students to get more humanities," said Wright, who also is president-elect of the National Assn. of Advisors for the Health Professions Inc. "The Mount Sinai program takes that to what some might say is an extreme. The program really does deviate from the norm of what most applicants look like and what most medical schools would consider is necessary."
An ongoing debate
In the early 1900s, Flexner crisscrossed the U.S. and Canada evaluating 155 medical schools for his Carnegie Foundation for the Advancement of Teaching report, written at the behest of the American Medical Association Council on Medical Education.
He determined that new students needed a solid foundation in the basic sciences.
"By the very nature of the case, admission to a really modern medical school must at the very least depend on a competent knowledge of chemistry, biology and physics," Flexner wrote in his 1910 report. "Every departure from this basis is at the expense of the medical training itself."
In 1984, a panel established by the AAMC released its "Physicians for the Twenty-First Century" report, which said medical school admission requirements limit students. "The result too often is premature specialization and failure to obtain a broad, rigorous education," the report said.
In 2009, a joint committee of the AAMC and the Howard Hughes Medical Institute released a report that called for restructuring standard admission requirements to focus on scientific competencies instead of course credits, while allowing more freedom to study nonscience subjects.
If medical schools want applicants to have more humanities credits, that is one thing, Wright said. But it gets complicated if the schools want undergraduate institutions to restructure traditional science courses. Small colleges don't have the resources to tailor their curriculae to premed students to the detriment of other science majors, he said.
"The ongoing debate is a little abstract to the average adviser. What we want to know is what do the medical schools want? How does this affect me and my students?" Wright said.
The Mount Sinai program is unique in the U.S., said Dr. Sondheimer, of the AAMC. A few Canadian medical schools don't require the MCAT and have varied course admission requirements. Those schools include McGill University Faculty of Medicine in Montreal and the University of Ottawa Faculty of Medicine in Ontario, said Dan Hunt, MD, co-secretary of the Liaison Committee on Medical Education, which accredits medical schools in the U.S. and Canada.
In 2005, Northern Ontario School of Medicine was the first new school of medicine to open in Canada in nearly 30 years, said Dr. Roger Strasser, the school's dean. MCAT scores and traditional science prerequisites are not required.
So far, about 70% of graduates have entered family medicine residencies. Others have gone into fields such as general surgery or pediatrics. Like the HuMed students at Mount Sinai, nonscience students at Northern Ontario struggle initially but ultimately perform as well as their peers.
"There doesn't seem to be a difference with them," Dr. Strasser said.
Although Mount Sinai's program adds to the debate on undergraduate requirements for premed students, Dr. Sondheimer doesn't expect U.S. medical schools to change their admission standards in the near future.
"This is only going to continue this discussion of whether the medical schools should go away from these traditional prerequisites," he said. "That is an active debate right now."