• Building better doctors

    While the NYT trash-talks legal education, medical schools are revising the MCAT to “reward candidates who have read broadly in the liberal arts and can think analytically.”  This is a change.

    This new focus aims to encourage aspiring physicians to come to medical school having considered what makes us human, how we interact with other human beings, and how human behaviors have shaped civilizations and society.

    That’s from the Dean of the Harvard Medical School, writing in NEJM.

    The MCAT revision complements efforts by some medical schools to reserve a portion of their classes for humanities students who lacked traditional pre-med education as undergrads.  Not to put too fine a point on it, but stellar success as a pre-med may not correlate perfectly with the social skills needed to be an excellent primary care doctor.

    One program, the Mt. Sinai Humanities and Medicine Program, has reported encouraging results:

    Results: There were no statistically significant differences between the groups in clerkship honors other than psychiatry (HuMed students outperformed their peers, P < .0001) or in commencement distinctions or honors. Although HuMed students were significantly more likely to secure a scholarly-year mentored project (P = .001), there was no difference in graduating with distinction in research (P = .281). HuMed students were more likely to have lower United States Medical Licensing Examination Step 1 scores (221 ± 20 versus 227 ± 19, P = .0039) and to take a nonscholarly leave of absence (P = .0001). There was a trend among HuMed students toward residencies in primary care and psychiatry and away from surgical subspecialties and anesthesiology.

    Conclusions: Students without the traditional premedical preparation performed at a level equivalent to their premedical classmates.

    Muller D, Kase N. Challenging traditional premedical requirements as predictors of success in medical school:  the Mount Sinai School of Medicine Humanities and Medicine Program.  Academic Med 2010;85:1378-1383.

    In law schools, the USNews ranking system generally punishes experimentation like this.

    • Kevin-Great post! It’s encouraging to hear about the new MCAT–great find. We did a post on a similar column by Shannon Brownlee a couple of weeks ago–you might want to check it out!

    • I don’t know anything about the licensing exam. I understand that a statistically significant difference isn’t always important from a clinical or practical standpoint. Is a six point difference to small to consider important?

    • Any changes to the MCAT would need to be matched with changes to the pre-clinical/basic science years.

      The Sinai data is good to see, but I wonder if the results are replicable at other institutions…

    • Meh, medical schools have been emphasizing non-science majors and general skills for more than a decade now. I’m not sure how Sinai missed the boat. If anything, it might be time for a swing back in the other direction.
      A lot of english major with public health aspirations who couldn’t describe a gene if it licked them in the face.

    • To avoid hurting the feelings of those already in the profession, perhaps a less judgmental title would be “Building a different kind of doctor”

      This was “new” 30 years ago when I was in med school. Think of it as an eight year process, and those of us who labored through pre-med and biology majors had more time the first two years of med school to enjoy leisure and culture, while all those philosophy and literature majors had to grind hard in med school to catch up. Most of us ended up in the same place at the end of the eighth year.

    • Most docs are kind of geekish. We tend to select for people who do not have especially good people skills as they are secondary. Then, residency training takes away a lot of the rest of those interpersonal skills. I suspect that choosing older students with more life experience might reduce the cynicism so many docs develop in residency, but that is probably not economically optimal.


    • Students without the traditional premedical preparation performed at a level equivalent to their premedical classmates.

      As do NP’s, PA’s and midwives.

      Skill at school correlates with skill at delivering care but not so strongly. This is another reason that we need to make it easier to become a doctor or nurse etc.