Essay warns against too much of a shift away from science in training future doctors

An organic chemist I know tells her doctors that she is a professor of Southern literature whenever she is in the hospital. That’s because organic chemistry has come to symbolize all the irrelevant science hoops that premedical and medical students jump through on the way to becoming physicians. Today, we are told, medical students should be learning “people skills,” placing medicine in the context of the community and learning how individuals make choices related to their health. These preferences are reflected in the revised medical admissions test rolled out earlier this year, with its newly added questions related to sociology, psychology and the humanities. This summer, as interviews begin at medical schools around the country, candidates who want to make the final cut are sometimes playing down their science credentials in favor of their relational skills.

This seems to me to be a false dichotomy. To be sure, I want my physician to understand how to deal with me as an individual and as a member of my social group. But I also want her to appreciate the underlying molecular nature of disease and to know how to evaluate scientific and statistical evidence about clinical trials and treatments.

The movement away from science springs from a misunderstanding that is not limited to the premed curriculum. Many people have the experience of science taught as a series of isolated facts to be memorized. All physicians recall memorizing biochemical pathways for which they have no use past the final exam in a given course. If there were ever a time when memorization had a place, that time is gone. Facts are cheap and readily available on every smartphone and computer.

The truth is that science is about so much more than memorizing a set of facts. Practitioners with a solid scientific grounding are able to analyze data and put that data in context, rely on what is known from previous studies and extrapolate to the future, and understand how changing environmental conditions are reflected in bodily conditions.

I have taught biochemistry to medical and undergraduate students for over 30 years. Premedical students usually come into my classes expecting to memorize structures, nomenclature, and pathways and are a bit taken aback at the idea that there is anything to learn other than that. By examining experimental data and case studies they become familiar with the core of biochemistry and are able to go far beyond rote learning. Unfortunately I hear back from them once they are in professional schools that, “it was great that you taught us about concepts, but you should have had us memorize more since that is what we have to do here.” As long as the health professions emphasize the acquisition of facts rather than their application, science will be seen as dry, uncreative and mostly irrelevant to the “real” world.

Along with colleagues at Wellesley -- Lee Cuba and Alexandra Day -- I recently published a study of science majors at liberal arts colleges. Our major finding was that science majors who took many courses outside of the sciences were better able to make connections among disciplines. Some medical schools -- Mount Sinai in New York is a prominent example -- have begun recruiting humanities majors to their classes, requiring fewer science courses than for the typical applicant because they are thought to bring different strengths to the profession. This move is well intended, but it misses the point.

Privileging humanities majors in medical school admissions may inadvertently reinforce the opposition between the “soft skills” associated with humanists and the technical capabilities associated with scientists. Long before the health sciences became deeply specialized, renowned physicians such as Hippocrates, Maimonides, John Locke and John Keats were as much philosophers and poets as scientists. Although that kind of Renaissance career may no longer be practical, today a strong liberal arts education in both the arts and sciences provides the most effective preparation for the medical profession.

Medical schools would do better to recruit broadly educated science students who bring the complementary strengths of integration among disciplines and a deep grounding in the process of scientific discovery and analysis to their study and practice of medicine. If we want knowledgeable and competent doctors who are also well-rounded and compassionate individuals, we must stop treating the arts and sciences as mutually exclusive. We must help our students see the connections between what they are learning in the classroom and what they will practice in the “real world,” to see that organic chemistry and Southern literature are not irreparably separate, but that each may have a role in a medical education.

Adele Wolfson is Nan Walsh Schow and Howard B. Schow Professor of Physical and Natural Sciences and interim dean of students at Wellesley College.

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A new study in Proceedings of the National Academy of Sciences suggests that there’s a dependable way to foster long-term improvements in students’ critical thinking skills. Researchers at Stanford University and the University of British Columbia developed a framework consisting of cycles and decision making based on comparisons between data sets or data and models, and applied the learning structure to 130 students in an introductory physics lab.

During a series of simple physics experiments, the students received instructions to compare new data to existing data, and to decide how to act on those comparisons based on statistical tests. For example, students used a stopwatch to time a pendulum swinging between two angles of amplitude. Rather than just conducting data and comparing them to equations in a textbook, as a control group of students did, the students in the modified course were instructed to make decisions based on the comparison. What should they do to improve the quality of their data and better explain the difference between their results and the equation in the textbook? Students chose everything from conducting more trials to putting the team member with the biggest finger on stopwatch duty. Their data improved, along with their understanding of the process.

Even after the instructions were taken away, the students in the test group were 12 times more likely than a group of 130 students the previous year (the control group) to propose changes to improve their data or methods. The test group students also were four times more likely to identify and explain a shortcoming of the model using their data.

The test group students demonstrated similar critical thinking skills in a second course the next year, suggesting that their learning was long-term. Lead author N. G. Holmes, a postdoctoral researcher in physics education at Stanford, and her co-authors argue that the framework they developed could be adapted to a range of settings beyond physics. The study is available here.

Holmes said via email that "giving students the space to make decisions about how to follow up on an experimental result, with careful guidance, ingrained critical thinking long-term. … I think this adds to the existing literature a concrete, yet simple way to structure how these skills can be taught with lasting improvements. It is a demonstration of how to teach expert-level skills in context that can be generalized outside a particular classroom."

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