Reforming Pre-Med

What does it mean to replace a set of pre-med courses with competencies that might be fulfilled with any number of courses? That’s a central question for those who think, as I do, that the report “Scientific Foundations for Future Physicians,” released by the Association of American Medical Colleges, in collaboration with the Howard Hughes Medical Institute -- and featured recently by Inside Higher Ed -- must become a topic of discussion in higher education. As an educator, dean, and contributor to the report, I believe it is critical that educators, administrators, professional organizations and foundations begin immediately with a close examination and debate of the report’s recommendations, if we are to prepare medical professionals more effectively and inspire students to engage in scientific inquiry.

To be sure, the debate will be complex. Even I -- a member of the committee that produced the report -- must confess that the idea of doing away with the list of pre-medical courses appealed to me as an educator but concerned me at first as a college dean: What would be the cost of change and how would a college pay for it? Tim Austin, vice president for academic affairs and dean of the College of the Holy Cross, articulated this concern in his comments to Inside Higher Ed: "I simply want to be realistic about the massive scope of the changes that the committee proposes."

In due course the educator eventually quieted and comforted the administrator, who came to realize that an approach based on competencies will enrich the scientific and medical communities without necessarily overburdening colleges and universities already challenged by an economic recession. Let me explain.

At its core, “Scientific Foundations for Future Physicians” upholds what I regard to be an important goal of liberal education: to explore and discover connections between different threads of human thought and experience. Scientists and engineers trained in the tradition of the liberal arts understand the socioeconomic and political contexts of global challenges, and are more likely to find solutions that affirm human rights, protect the environment, and raise standards of living across the globe. With medicine becoming ever more reliant on advances in science and technology, medical professionals also must learn to make connections within the sciences and between the sciences and other disciplines. So medical schools look -- and will continue to look -- for intellectual breadth in applicants.

In the area of scientific foundations, preparation for medical school must include study of the principles and basic tools of mathematics, statistics, physics, biology, and chemistry. After all, when else but during their college years will medical professionals be exposed to, for example, the mathematics that can predict the progress of biochemical processes, the ideas that led to the development of ultrasound and MRI techniques, or the ability to synthesize biomedically active molecules in the laboratory?

Of course, the current pre-med curriculum, based on a rather inflexible menu of courses, already delivers basic concepts of science to students. But the challenge posed to educators -- and yes, administrators -- by “Scientific Foundations for Future Physicians” is the notion that mathematical and scientific content should be presented in context, preferably by emphasizing interdisciplinary approaches in the classroom and laboratory. Robert Alpern, co-chair of the AAMC-HHMI Committee, asserts correctly that the curriculum could “become much more interesting.” More importantly, making explicit connections between the traditional disciplines of science could lead to a long-overdue revolution in undergraduate mathematics and science education that will benefit not only pre-medical students, but all students -- even those who will not study mathematics and science beyond what is required in a general education program. The educator in me accepts the challenge and welcomes change that may result not only in broadly educated scientists, engineers, and medical professionals, but also in enhanced science literacy for all.

Moving along a pragmatic path to reform might well require short but intentional -- and not necessarily very costly -- steps. For example, a general chemistry or physics course need not be overhauled completely to present the subject in the context of biomedical science. Close reading of the undergraduate competencies related to chemistry and physics shows that the cores of these disciplines, as taught in traditional introductory courses, are preserved. The AAMC-HHMI Committee realizes that supporting biology or pre-medical education is not the only -- indeed not even the primary -- goal of modern curricula in physics and chemistry.

At the same time, interdisciplinary links to biology are stronger than ever, and introductory courses in chemistry, physics, and mathematics already are highlighting such links, just as they also underscore connections to environmental science, materials science, and technology. The connections and context that “Scientific Foundations for Future Physicians” challenges educators to strengthen can come from targeted examples in the classroom and laboratory that map chemical, physical, and mathematical concepts onto biological and medical concepts. And the report suggests many examples without being prescriptive: for example, comparing data sets using informatics tools; applying geometric optics to understand image formation in the eye; and applying understanding of concepts of chemical reactivity to predict biochemical processes, such as enzyme catalysis.

I suggest that, at a minimum, enrichment of existing courses (such as introductory chemistry and physics) along the general lines indicated by the report could be part of what we should expect of all educators: perennial examination and improvement of curricular materials in an attempt to keep content fresh, students actively engaged, and the faculty energized. To be sure, lower-level mathematics, physics, and chemistry courses would be those most in need of examination, but also biology courses would have to strengthen links to other science courses if students are to understand and retain material at the interface between the disciplines.

More ambitious and rapid changes -- such as creation of brand new courses taught by two or more instructors linking different disciplinary perspectives -- would be more costly to design, implement, and sustain, but such bold moves are not strictly necessary. But if a college or university does wish to move more boldly, it is useful to note that major curricular innovation is indeed promoted by a number of foundations and federal agencies in positions to underwrite initial efforts. Moreover, science education is a common focus area at regional and national meetings of professional scientific societies, so that dissemination, sharing, and evolution of new best practices could happen naturally.

I already hinted that, after some soul searching, the educator and administrator in me reconciled. After all, a pre-med curriculum based on well-articulated competencies is also consistent with the goals of mathematics and science education in the tradition of the liberal arts: integration of quantitative and scientific reasoning -- in particular the scientific method of inquiry -- into a full description of nature and culture. So let us use our collective experience as educators to construct an exciting, innovative, and interdisciplinary pre-medical curriculum with the same energy and creativity that we apply to the periodic reinvention of general education programs at our home institutions. And in so doing, let us also imagine ways to reform mathematics and science curricula across all of higher education in America.