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The Future of Pre-Medical Preparation
New York, NY
Pre-medical preparation is changing in meaningful ways for the first time in over a century. Our goal at Icahn School of Medicine at Mount Sinai (ISMMS) is to accelerate that change from evolution to transformation.
History and Context
Over 25 years ago we created a program called Humanities and Medicine (HuMed) which allowed college sophomores studying the Humanities to apply for early acceptance to our medical school. They were required to complete their undergraduate studies, did not have to take many of the traditional pre-med basic science requirements, and were exempt from taking the MCAT. Over the years the program grew from a handful of liberal arts colleges and a small number of matriculating students, to HuMed candidates from any university in the country making up one third of every ISMMS incoming class. Medical school performance outcomes for HuMed students have been outstanding.
Four years ago we expanded HuMed (now FlexMed) to include any undergraduate major, and plan to take up to half of every incoming class from this cohort.
FlexMed allows accepted candidates to explore the breadth and depth of what an undergraduate education has to offer. It provides students the opportunity to delve into fields of learning that will make them better doctors, better scientists, better colleagues, and better members of society. Without the time and academic constraints of the MCAT and many of the traditional science requirements, students are able to take academic risks by challenging themselves with coursework and independent study from which they might otherwise have shied away for fear of jeopardizing their GPA. They can spend months that otherwise would have been dedicated to MCAT preparation, doing research, community service, working on a thesis, and developing their leadership skills. FlexMed also allows us to recruit a more diverse class since our candidates have not been victim to the infamous “weeding out” process that is emblematic of most pre-med environments.
In June of 2014 we were fortunate to receive generous funding from the Macy Foundation to bring together groups of colleagues who represented a broad cross-section of educators, each of whom saw the pre-med process through a different lens. The groups included pre-health advisors, undergraduate science professors, medical school admissions deans, directors of pipeline programs, directors of post-bac programs, and thought leaders from the Association of American Medical Colleges.
Each group educated the rest of the participants on the nuances of their group’s role, its challenges and opportunities, best practices and innovations. We then created mixed or inter-disciplinary groups and they developed a proposal to address a challenge or constraint that was identified in the first set of presentations.
What we decided
The discussions were lively and provided us with a rare opportunity to commiserate, celebrate, and support each other’s work by realizing how closely aligned our goals were. We shared trade secrets and came to the following conclusion:
- It is clearer than ever that we need to focus on what’s missing from pre-medical education: academic rigor with less grades-driven competition; curricular flexibility and opportunities for self-directed learning; coursework that is more closely aligned with society’s needs; a variety of paths to medicine that will enable us to achieve greater diversity in our student bodies and the American health care workforce. The 20,000 students who enter medical school every year are remarkably accomplished, but for the most part have achieved great things despite, not because of, their pre-medical preparation. Our current model subjects smart, creative, passionate students from across the broad spectrum of American life to an educational experience that detracts from their ability to be independent, self-directed, collaborative learners. It does not nurture the attributes they will need to care for the underserved, perform breakthrough research, and fix our health care system. The primary purpose of pre-medical preparation is meeting societal needs related to health care for all and scientific discovery.
Recommendations for the field
- We must develop more diverse paths to medical school, with more flexible and more holistic admissions requirements
- We must focus on enhancing the diversity of the physician and scientist workforce
- Using the MCAT as a key criterion for admissions and national school rankings does more to undermine the pre-med process and the education of physicians in this country than any other single factor
- By establishing requirements and priorities, medical school admissions committees set the tone and the standards, and therefore must be the drivers of change
This blog is a call to action!
David Muller, MD is Dean for Medical Education at Icahn School of Medicine at Mount Sinai. He is a graduate of Johns Hopkins University (B.A.), NYU School of Medicine (MD), and completed his residency in Internal Medicine at Mount Sinai Medical Center. He is Professor of Medical Education and Medicine and cares for homebound patients in the Mount Sinai Visiting Doctors Program.