New Foundations for Future Physicians

Photograph of Sharon Long

Sharon Long

Photograph of Robert J. Alpern

Robert J. Alpern

Preparing future physicians for 21st-century medicine will require energizing premedical and medical education, says Sharon Long, a professor of biology at Stanford University. Doing that in a way that both engages students and satisfies the specific requirements of medical school is difficult but feasible, she says, adding that it presents an exciting educational opportunity for science faculty in all institutions of higher education.

Together with Robert J. Alpern, dean of the Yale University School of Medicine, Long co-chaired a committee of researchers, physicians, and science educators who have challenged the status quo in the system that trains future physicians—which today leaves little room for innovation in the undergraduate classroom. The committee’s goal is to create a new system that caters to many learning styles; arms students with a scientific approach to problem solving; and encourages the creation of innovative, interdisciplinary courses.

Convened by HHMI and the Association of American Medical Colleges (AAMC), the committee issued a June 2009 report, “Scientific Foundations for Future Physicians,” arguing that medical schools should evaluate students on measurable competencies rather than their completion of a static list of courses.

The committee defined a competency as the knowledge, skill, or attitude that enables an individual to learn and perform in medical practice. “Instead of mandating a specific curriculum, what we should ask is, what should students be able to do?” says Long. “That’s a competency.”

Today’s MCAT, the universally accepted medical school entry exam, already tests competencies. But, says Long, it tests them in a way that presumes how they are taught, which can constrain the approach taken in the classroom.

“Imagine you’re on the ground floor of a building and you need to get one floor up to get a clear view out. There are steps, and there is a ramp. The MCAT assumes that you have to take the steps, and it tests every one of those steps,” she explains, “rather than assesses whether you are at the level you need to be and can see the view from there.” The committee recommended that both the medical schools and the developers of the MCAT—which is revised every few years—focus on the outcomes of instruction rather than the steps. That approach leaves room for a variety of instructional approaches toward the same educational goals.

Rather than suggesting either an increase or decrease in the number of requirements, the committee proposed substituting more relevant competencies for less relevant course requirements.

“A lot of the premed science requirements are irrelevant,” says Alpern, pointing to organic chemistry as an example. “You don’t need to understand petroleum processing to be a physician.” Instead of requiring premed students to learn all aspects of organic chemistry, he says, a better approach would be to combine medically relevant elements of organic chemistry and biochemistry into an integrated course tailored to the needs of future physicians.

Giving undergraduate faculty room for a little creativity, Alpern hopes, will ultimately mean that more students with a love of science will enter medical school. “When you talk to undergraduate students and ask what they think of the premed curriculum, they nearly always hate it,” he says. “Given how exciting science is today, we should be able to come up with a curriculum that inspires people.”

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Photo credit: Long: Linda A. Cicero/Stanford News Service Alpern: Michael Marsland/Yale University