What Makes a Premed

Rethinking the Way We Become Doctors

Down beneath the Science Center, between maintenance shops and the closed doors of laboratories, Geyser University Professor Henry Rosovsky, who co-teaches the overcrowded core course "Tradition and Transformation in East Asian Civilizations: Japan"--commonly known as "Rice Paddies"--glances over his notes before entering the lecture hall.

Into the windowless antechamber walks Baird Professor of Science Dudley R. Herschbach, just finished with his early morning freshman Chemistry 7 lecture. Hershbach, Harvard's most active professor in the drive to "humanize" science curricula, throws a pointed question at the unsuspecting Rosovsky.

"You tell the students, of course, the most important thing?...why it's rice paddies and not wheat?"

Apparently, Rosovsky does not tell his students "the most important thing," and Hershbach must explain that billions of East Asians have cultivated rice for thousands of years because rice doesn't deplete soil nutrients.

Hershbach's aim is not to chalk up another point for science, but rather to debunk the myth that science and the social concerns of the humanities are "two cultures" radically opposed to each other.

The students who suffer most from that myth are the premeds. Contrary to the spirit of a liberal arts education, premedical students, striving for one of the precious spots in a medical school, devote more than one-third of their college educations to preparing for medicine. The rigorous requirements, as Assistant Professor of the History of Medicine and Science Allan Brandt puts it, "have polluted undergraduate education."

Yet, while both medicine and education have changed radically in recent years, the philosophy behind the premedical curriculum for years changed very little.

That is, until now.

In response to criticism of medical education form both faculty and students at Harvard and across the nation, Herschbach and other Harvard experts--including Gerald S. Foster, dean of admissions at Harvard Medical School--have taken the initiative and instituted changes in the chemistry curriculum.

The new "life science"-oriented Chemistry 17 and 27 sequence, specifically designed for premeds, is expected to clear up the organic chemistry bottleneck. In the past, both chemistry concentrators and premeds had been funneled through the same notorious course, Chemistry 20, despite their widely different educational needs.

Furthermore, Foster and other concerned faculty, in a drive coordinated by Hope W. Wigglesworth, premedical counselor at the Office of Career Services (OCS), have sent letters to the deans of the nation's 127 medical schools requesting that they accept Harvard's new chemistry courses for admissions.

The letter specifically calls for overall changes in medical school admissions policy, including a provision to allow Advanced Placement (AP) test scores in chemistry and physics to count toward admissions requirements. Herschbach, chairman of the Curriculum Committee in Chemistry, sees these reforms as steps in a "larger campaign to encourage medical schools to define admissions criteria by content, not by 'units.'"

Early responses have shown widespread receptiveness to the plan. And as of the summer, 13 medical schools, including those at Harvard, Yale, the University of Chicago, and Case Western, had accepted the reforms.

The move to alter the premedical curriculum follows criticisms such as those noted by President Bok in his 1983-84 annual report, where he called for an end to the intrusion of medical school admissions policy on undergraduate education.

At Harvard, Dean of the Faculty A. Michael Spence plans to establish a formal committee comprising faculty from both the College and the Medical School to "work out a proposal for premedical education [and] produce a viable plan or set of options."

For all the efforts at Harvard, however, its activity lags behind that of some other schocls. Last spring, officials at the Johns Hopkins University School of Medicine said they will eliminate the MCAT as an admissions requirement.

The move received varied appraisals. For example, Foster says he has "mixed feelings" about the change. As to Harvard Med's admissions policy, the dean said he does not forsee any change regarding the MCAT requirement.

Instead, he says, he prefers to recognize reforms in undergraduate curricula--clearing away the "science roadblocks"--as the most significant steps toward better premedical education.

Echoing the recommendations of an influential 1984 report on general medical education by the Association of American Medical Colleges, Foster cites "effective communication skills" and the ability to "study independently" as keys to preparation for medical school.

But even if Harvard and other schools fail to go as far as Johns Hopkins in limiting the MCAT's role, Foster and Hershbach say, the standardized entrance exam will continue to be reevaluated.

Course changes that may humanize the science curricula, focusing on health applications and contexts, may also leave students clueless in front of MCAT exams, or out in the cold in the face of stringent medical school requirements.

In addition, some view the current MCAT as "superficial," testing only the surface of the basic science learned in premedical courses. Critics also point to what they believe is its disproportionate influence. Furthermore, many feel that the MCAT simply cannot measure or predict a student's clinical capabilities--in other words, it says nothing about how good a doctor a student might become.

Most educators agree that the MCAT and medical school admissions policies will not change until undergraduate and graduate teaching are changed. But experts foresee a problem in doing this. They must change what goes on in the classroom in order to reform the criteria by which students are judged, yet they are limited in how they can change curricula by those same criteria.

The key to resolving this dilemma, experts say, lies in the newly developing cooperation and communication between colleges and medical schools.

Joint efforts are already seen as responsible for the Harvard-initiated reforms in premedical education such as the new introductory chemistry curriculum, which has already been greeted with enthusiasm from both premed students and tutors.

But what of the reason for reform in the first place, the emphasis on the basic sciences now widely considered undue?

The pre-med syndrome is not a personality trait, not a row of haggard faces bent over Cabot Library tables that readily double as formica pillows. It is, experts say, a combination of medical school admission policies and pressures, embedded in certain beliefs among the medical community at large.

As Professor Brandt remarks, the "tremendous hope that the answers to social medicine could be worked out at the highest levels of biochemical research" has fostered the emphasis on basic science in pre-medical and medical education. It is precisely this belief that may be changing