Abraham Flexner published his landmark report on undergraduate and medical school preparation of physicians in 1910. Within a few decades and continuing throughout the remainder of the 20th century, there have been admonitions to enhance, overhaul, or abolish the “traditional” pre-med requirements that he established.
The reasons for this dissatisfaction are self-evident:
- The pace of scientific discovery and its clinical application has far outstripped the current century-old requirements.
- The age of information technology has made memorizing vast amounts of content unnecessary.
- The current requirements lack clinical, scientific, and social relevance.
- The traditional requirements are used to ‘cull the herd’ of talented aspiring physicians.
- The requirements disproportionately disadvantage minority and female students who are desperately needed to maintain diversity in our healthcare workforce.
- The requirements consume so much time and effort that few students end up being grounded in bioethics, social justice, and health policy.
- A rigid and highly structured pre-medical curriculum, followed by a rigid and highly structured medical school curriculum, deprives students of the ability to develop the critically important skill of lifelong self-directed learning.
Perhaps most important, the current model has perpetuated “pre-med syndrome,” an undergraduate culture of aggressive competition for grades that runs counter to what we value most in medicine: academic and intellectual rigor, creative thinking, teamwork and collaboration, and social conscience.
Several authors have gone to great lengths to point out that the medical students we’re producing are not flawed but rather are products of a warped educational system. They “make rational decisions to optimize their success on measures by which they will be judged,” and therefore “we must stop complaining about the problematic choices made by premedical students and [instead] start fixing the system that is fostering such choices” (1).
And yet there has been no substantive change. We know full well that 1) undergraduate institutions are neither equipped nor motivated to provide pre-medical science courses that are geared toward future physicians, 2) adding more translational science and some of the humanities to the pre-med requirements is disingenuous; more requirements and a longer MCAT will merely worsen student well-being and exacerbate pre-med syndrome, and 3) the MCAT is an enormous drain on the time, and the intellectual and financial resources of pre-medical students. It effectively excludes brilliant, creative, motivated people who are not strong test takers and disproportionately affects disadvantaged students who cannot afford to take extensive, expensive MCAT prep courses.
Uncoupling pre-med preparation from the MCAT will give students the opportunity to demonstrate excellence in other ways. It will also enhance the diversity of Mount Sinai’s applicant and matriculant pools, and in time, it may encourage schools to develop more appropriate criteria upon which to base admissions decisions.
What do we want in pre-med preparation?
- Academic rigor with less grades-driven competition,
- Independent mentored scholarship,
- The flexibility for college students to pursue a wide variety of undergraduate majors,
- Flexible, self-directed educational plans that foster lifelong learning,
- More scientifically and clinically relevant science coursework,
- More exposure to courses that inculcate a sense of social responsibility and an appreciation for the social, political, and financial context within which medicine exists.
We invite you to learn more about FlexMed, including our approach to this critically important aspect of educating tomorrow’s physicians. The Icahn School of Medicine at Mount Sinai is reviving Abraham Flexner’s legacy of visionary, radical change to better align education with the needs of society. Discover FlexMed at http://icahn.mssm.edu/flexmed or visit us on Facebook, Twitter, YouTube and LinkedIn. We are changing education today to create the leaders of tomorrow.
David Muller, MD, is the Dean for Medical Education at Icahn School of Medicine at Mount Sinai. Dr. Muller also co-founded and directed the Mount Sinai Visiting Doctors Program and is the Professor and Chair of the Department of Medical Education.
1. Kanter SL. Toward a sound philosophy of premedical education. Acad Med 2008; 83: 423–24.