SCIENCE

Three Classes Wannabe Doctors Should Take Before Med School

August 2, 2010

Last week, the New York Times published an article about a little known practice of at least one medical school: accepting students who have not taken courses in science—biology, chemistry, organic chemistry and physics—or the MCAT entrance exam.

The students apply in their sophomore or junior years in college and agree to major in humanities or social science, rather than the hard sciences. If they are admitted, they are required to take only basic biology and chemistry....They forgo organic chemistry, physics and calculus—though they get abbreviated organic chemistry and physics courses during a summer boot camp... . They are exempt from the MCAT.

The traditional pre-med science courses present an "obstacle" to many students, one doctor says in the article, and end up weeding out people who might make good doctors, perhaps even more well-rounded doctors. (These classes also weed out many potential biologists, which I discovered as an undergraduate biology major at Cornell University. I found it a bit annoying for those not headed into medicine, but I also thought it somewhat heartening that those who couldn't hack it in basic biology wouldn't one day end up in the doctor's exam room with me.) Most of the article's commenters, who include quite a few doctors, however, aren't buying it:

As a both physician and musician, as much as I am happy to hear more respect paid to the artistic bent of applicants, I do not know where I would be as a practicing physician if I had not majored in biology during college. Yes it was rigorous, yes I had to count fruit flies at 3 AM, yes organic chemistry was very intense, but it was not in medical school I recognized the importance of these courses. It was in residency and as I started practicing when I would find myself continually reaching back to these basic scientific principles in diagnosing my patients and formulating a treatment that made sense.

Of course, there's nothing to prevent humanities and social science majors from taking hard science courses in addition to their major. I ran into plenty of pre-med political science and English majors in college. And I wonder whether it actually might be time to expand, not eliminate, the science requirements for pre-med students. Our understanding of human biology has advanced greatly over the past few decades. The three courses below are usually required of biology majors and have plenty of relevance to modern medicine. Should wannabe doctors have to take them, too?

Evolution: Evolution is at the base of all of modern biology. Knowledge of evolutionary theory makes much of the rest of biology far more understandable. But beyond that, the world of medicine is one of the places where we see evolution in action. Bacteria and viruses keep evolving. That's why there's a new flu vaccine every year and why we have drug-resistant strains of diseases. I'm not alone in thinking evolution an important part of medicine. "Simply put, training in evolutionary thinking can help both biomedical researchers and clinicians ask useful questions that they might not otherwise pose," three scientists wrote in a Science editorial in 2006.

Genetics: Our genes are already playing a role in medicine. Women who have a family history of breast cancer, for example, can be tested for breast cancer genes and make decisions, such as choosing prophylactic surgery, to dramatically reduce their risk of cancer. Fruit fly experiments—the classic genetics experiments in any college course—seem unrelated, on the surface, to this patient example, but they provide an unforgettable lesson on the basics of the topic. A doctor's first action when presented with the patient above may be to send her to a genetic counselor, but that doesn't mean that knowing genetics isn't necessary (and most med schools do teach medical genetics in the first year). And knowing the basics may be even more helpful. Right now genetics may play its biggest role in relation to specific diseases and in explaining the results of practically useless home DNA tests (the likes of which the Government Accountability Office recently said had "no scientific basis"), but it's only going to become a bigger part of our medical futures.

Biochemistry: This is the course that teaches about all of the chemical reactions that happen inside living organisms. A handful of medical schools require it, and many others encourage that applicants take it. Most teach it in some form. That's because so much of our health—and our healthcare—depend on things going on at the cellular level. Diabetes, for example, is fundamentally a chemical problem: cells can't use the molecule insulin. How drugs interact with our cells, another example, matters for how the drugs work to treat a disease or condition, what side effects they may have and how they interact with other drugs inside the body.

I hardly believe that I'm arguing for more pre-med students in classes for biology majors. When I took these courses, I enjoyed them, in part, because there was no thought of weeding out pre-med students at that point. The professors simply concentrated on filling our heads with science. But I do think that they cover areas that are now fundamentally important to modern medicine. Would making pre-med students take them make for better doctors, or would it drive more people into law school? What subjects do you think that pre-med students should study as undergraduates?