PMY 182 : Should the Premed Path Be Reworked?

Session 182

In today's episode, Ryan talks about a guest post featured on the Scientific American Blog called It's Time to Retire Premed, written by a medical student. It mentions that “The existing system of premedical education is broken. It needs to be fixed.” Listen in as Ryan sifts through the article and gives his opinions point-by-point.

Here are the highlights of today's conversation:

What it's like to be premed?

  • To cheer at somebody else failing is not a premed student
  • To cheer at somebody else failing is a classless human being.
  • Trying to get ahead at the expense of others is a symptom of being a bad person and nothing to do with being a premed student.

“Premed can be one of the most brutal and dehumanizing parts of medical training”

  • The term dehumanizing is challenging.
  • Wherever you are at this point, think about a part that has been dehumanizing.
  • The premed path is hard but you're doing it towards a goal of becoming a physician to have the privilege to treat people.
  • You have to respect the hard stuff

Prerequisites are outdated and don't necessarily make a good physician. It is a broken system that has to be fixed.

  • Ryan highly disagrees with this statement
  • Being a premed is not a broken system because having a system is necessary
  • What is broken is the information inside the system inside the premed world perpetuated by SDN (Student Doctor Network) and premeds that don't know anything other than what they've read on SDN.

The required basic science classes have become largely irrelevant to modern medicine.

  • A false and ridiculous statement
  • The basic sciences help you build the foundation of knowledge and information about how we as humans and your future patients work.
  • Basic sciences teach you to think critically and the scientific method vital to being a physician

Being a cutthroat premed student:

  • Collaboration not competition
  • Helping a classmate won't hurt your chances of getting into medical school
  • The only competition for medical school is you.
  • You control the curve, not your classmates.

Weed out courses and chopping students who can't cut it:

  • Organic chemistry as a weed out course
  • Thinking required for organic chemistry is different

How we all want compassionate, well-rounded physicians to care for us:

  • Putting patient interest first
  • People who are not hard science majors having experience outside of the hard sciences are sometimes more well-rounded than other students.

The FlexMed program at ICAHN School of Medicine:

  • A humanities-based program that accepts students who apply during their 2nd year of undergrad
  • If accepted, no MCAT required and other upper level science courses required by most medical schools
  • The FlexMed program requires a year of college chemistry, biology, and a semester of physics (so you still need the basic sciences to apply to FlexMed)
  • You don't have to be a hard science major to go to medical school

Some pieces of advice for premed students:

  • A good premed student is learning how to be a good human, a compassionate person. But you need those science classes to be a good physician.
  • You have to do this to help patients because you have to have solid science foundation to be a knowledgeable physician.
  • The key to being a great physician is being compassionate, well-rounded, can work in teams which all come from being a good person.

Links and Other Resources:

www.medicalschoolhq.net/group

FlexMed program at ICAHN School of Medicine

MSHQ Session 16

Scientific American Blog article, It's Time to Retire Premed

Gap Medics

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Transcript

Introduction

Dr. Ryan Gray: The Premed Years, session number 182.Hello and welcome to The Premed Years where we believe that collaboration, not competition, is key to your success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician.

Now if you're not part of our Facebook hangout group, you need to be. Go to www.MedicalSchoolHQ.net/group and click ‘Join This Group' I think is what the button says, and you will be part of our group. In this group, a lot of people have been sharing something recently about an article that was published on the Scientific American Blog, and it's a guest blog from a medical student, and the title of the article is, ‘It's Time to Retire Premed,' with the subtitle of, ‘The existing system of premedical education is broken and needs to be fixed.' That's what I'm going to talk about today, this article.

So I'll have a link to this specific blog post in the show notes for this specific podcast, which you can find at www.MedicalSchoolHQ.net/182. Now I want to go kind of stepwise through this blog post and talk about what I think is good, what I think is bad, and we'll talk about it in depth. If there's anything from this article, this blog post, that you disagree with what I'm saying, please go continue the conversation over at www.MedicalSchoolHQ.net/182.

Article – ‘It’s Time to Retire Premed’

Now he starts off- Nathaniel is the student that wrote this article, and he starts off by talking about a lab class, chemistry lab class that he's in, and how one of the students- one of the girls in the class dropped her beaker or whatever container she was carrying, and it broke. And one of the classmates cheered, did a fist pump and cheered that this girl dropped her beaker, because supposedly according to Nathaniel, this student was glad that somebody else had failed this experiment because that means that he would do better, the student that was fist pumping would do better. And he finished up with a one line thing that said, ‘This is what it's like to be premed.' And I disagree with that bold statement, because that's not what it's like to be premed. That's what it's like to be a person who doesn't care about other people. Now in my notes I originally wrote that, ‘This is what it's like to be a classless human being,' I kind of stepped back, although I still told you what I wrote down.

To cheer at somebody else's failing is not a premed student. To cheer at somebody else failing is a classless human being. Cutting down others isn't something you find only in the premed world though, it's not unique to being a premed student. Trying to get ahead at the expense of others is a symptom of being a bad person. It has nothing to do with being a premed student. I wouldn't want this person who's cheering at a classmate dropping their beaker to be my physician. Don't get me wrong, I don't want them to be my physician, but I also wouldn't want this person teaching my kids in school, I wouldn't want them serving me in a restaurant. It's just not somebody I would want to associate with.

Now let's step back and actually analyze what this student was doing. Were they truly cheering for the fact that this student dropped the beaker, and it supposedly made this person's job as a premed that much easier? I don't know if I agree with that because one of the things that we do as humans, we cheer when something happens. If you go to a sporting event and something bad happens, it's part of the sport, right? We cheer. If you're at a restaurant and you hear a server, or somebody in the back of the house, a cook or somebody drop a plate, or drop a tray of stuff, what do people do? They laugh, they clap, they cheer. So I don't know if this one person that's fist pumping and cheering and clapping is a premed student who's being so cut throat that they're getting ahead at the expense of their classmate, or they're just being a normal person and going, “Hey, good job, that was awesome,” and just kind of making it a statement in that way. I don't know, but if we go by what this student is saying, what Nathaniel is saying, this student is cheering at the expense of another premed student. That's not being premed, that's just being a bad person.

Is Premed Brutal and Dehumanizing?

Nathaniel goes on to talk about the premed path, and how hard it is to get into medical school, and then residency, and obviously becoming a physician. But Nathaniel says, ‘Premed can be one of the most brutal and dehumanizing parts of medical training.' Now Nathaniel is a medical student now, he hasn't had the fun of being a resident yet, or an intern. But I question the term dehumanizing. I challenge you to think back on your path, wherever you are at this point, and think about a part that has been dehumanizing; removing your human traits. Now I don't know what's dehumanizing about this path. If he's saying working hard towards a goal is dehumanizing, then I'm guilty, I've been dehumanized. Is the premed path brutal? I don't know if I would say it's brutal. It's certainly hard, but it's you're working hard towards a goal of becoming a physician. To be able to treat people, to have the privilege of treating people. I think that's a great goal, it's a hard goal to accomplish, and the journey to that goal is hard and it's long, but it's worth it. Now is it hard? Yes. Is it stressful? Yes. Are there long nights? Yes. Are there times when you doubt yourself? Yes. Are there times when you want to give up? Yes. That's not dehumanizing and brutal, that's working towards a hard goal. That's all, working hard towards a goal.

Now if you look at some articles that were published recently about millennials and having grit, I think maybe this article or that statement itself about being brutal and dehumanizing, I think we as a society are getting softer and softer. And so when somebody makes the decision to be premed, and wanting to go to medical school, we as a society have been getting softer. And so when we go through this process, we think it's the worst thing in the world because, ‘Oh my God it's so hard,' and ‘I didn't get a trophy every step of the way,' and ‘I didn't have a graduation after every step of the way.' I had some friends recently posting on Facebook about their kid graduating- having a graduation ceremony from like preschool, or kindergarten, whatever it was. And I just laugh. We celebrate way too much the easy stuff, and we don't respect the hard stuff, and I think this student is not respecting the hard stuff and he instead is calling it dehumanizing.

Flexner Report & Pre-Req’s

Now he does do a good job- Nathaniel does do a good job in this article about talking- talking about where a lot of our premed- our medical school pre-req's come from. Now he talks about going back into the early 1900's, how there was this Flexner Report for the Carnegie Foundation. Back in the day the admissions process into medical school, there weren't a lot of criteria, the standards were very low, and so Flexner came out with this report and said, ‘Here's what we should be looking at when we are evaluating premed students to get into medical school.' And that's where most of our pre-req's come from. So medical schools starting using this report, and what Flexner had talked about, and said, ‘Okay these are the requirements. All of the premed students who want to go to this school need to take all of these classes.' And historically it's been a year of biology, a year of chemistry, a year of physics, and organic chemistry, and usually some biochemistry in there as well. English for some schools as well. And the MCAT, obviously the test to get into medical school is a test that kind of formed around all of these pre-req's as well. So the MCAT test towards these pre-req's, the medical schools required the pre-req's, and that's a lot of what Nathaniel talks about in this article, is how these pre-req's are outdated and don't necessarily make a good physician. So this is what we're going to talk about.

He specifically says, ‘It's an outdated and broken system, and it has to be fixed.' Now I disagree with that statement. Being a premed isn't a broken system, and we'll dig into why I think it's necessary to have the system that we have. What is broken is the information that's inside the system, inside the premed world, perpetuated by Student Doctor Network for the most part, perpetuated by premeds that don't know anything other than what they've read on Student Doctor Network. And when you get that sort of information bouncing around everybody's heads, then it seems like you have to be a perfect 4.0 student, you have to take four years of hard sciences, you have to have a 4.0 GPA, you have to have thousands of hours of shadowing, and clinical experience, and travel the world, and cure cancer, and be the next Mother Teresa. That's what is broken with our system. The fact that that type of information keeps getting perpetuated day in and day out on websites like Student Doctor Network, and by premeds talking to other premeds. That's what needs to be fixed, and that's what we try to do here at The Premed Years, on Old Premeds, and just the Medical School Headquarters in general.

Basic Science Classes Irrelevant?

Nathaniel talks about how the first issue is that the required basic science classes have become largely irrelevant to modern medicine. Now Nathaniel isn't a physician yet, he's a fourth year, but he's to a point where he sees what knowledge is being used to by a physician. So I'm not going to knock him for not being a physician yet, but I'm going to say that this statement, that it's irrelevant to modern medicine, is completely false and ridiculous. The basic sciences help you build a foundation of knowledge and information about how we as humans, and how your future patients, how they work. It teaches you how to think critically. It teaches you the scientific method. These are vital to being a physician. Now is it true that I don't remember 99% of my undergrad basic sciences classes? Yes. I don't remember much of it. If I tried to take the MCAT today, I would fail miserably. If there was a failing score on the MCAT, which there isn't, I would fail. I would fail basic chemistry, basic biology at this point, because I don't use that specific knowledge. But it doesn't mean that I don't still use what I learned going through the process of taking those classes. What I've learned to pass those classes, to do well in those classes, what was taught to me I still learned, that's still part of me. The specific information that was tested day in and day out in those classes, I don't remember that but I use that information, that's now part of me and that makes me a better physician because of that. So to say that it's irrelevant to modern medicine is ridiculous. It's just- I don't even want to talk about it anymore because it's crazy.

He talks about the basic sciences- that basic science classes have turned into factories of cut throat competition. Now I'll go back to what I was talking about earlier. Being cut throat isn't part of being premed, it's part of being a bad person that doesn't know any better because they think that they have to be cut throat, because that's what Student Doctor Network has told them they needed to be. And this isn't a knock on Student Doctor Network, it's a very useful site outside of the premed world on there, there's tons of great information, I know the guy that started Student Doctor Network, but the students that are posting on Student Doctor Network are perpetuating this information that you have to be cut throat, that you have to get ahead of your ‘competition,' and if you've listened to this podcast enough you know that I talk about collaboration, not competition.

There are plenty of seats in medical school for students that deserve a spot in medical school. You can work well with your classmates, and everybody will do better because of that. You're not helping a fellow classmate- you helping a fellow classmate is not hurting your chances of getting into medical school. The only competition for medical school is you. That's all, it's just you. What he goes and talks about next, he says, ‘Making matters worse, professors frequently grade students on a curve. In other words, students' grades don't depend on their own performance, but rather the comparison to their peers.' And again this is one where I adamantly disagree with this. Your only competition is you. If you do poorly on a test and it's curved, you're going to do poorly. If you do very well on a test and it's curved, you're still going to do very well. You are in control of your own curve, only you. If you get 100%, the curve is not going to affect you very much. If you do very well, it's not going to affect you. You control the curve, not your classmates.

Weed Out Classes

He talks about how the classes have become known as weed out courses for their role in chopping down the students who can't cut it. And I'll agree with this point. Yes, organic chemistry is typically known as a weed out course. Organic chemistry is very different in the basic science world as far as medical school pre-req's because the thinking that is required for organic chemistry is different. There's just a different way of thinking for orgo that is required, and a lot of students don't do well with that, and that's where they go- you know what, they throw their hands up and they say, “I'm done being a premed student. I'll do something else.” I agree with that. But we'll talk a little bit more about this in a little bit.

One of the first things, besides the weed out part, one of the first things that I agreed with is his statement about how we all want compassionate, well-rounded physicians to care for us. That's exactly who I want as a physician. We want doctors who can work in teams, and who put patients' interests first. Yes, that's exactly who I want as a physician. He nailed that on the head. But they're not mutually exclusive. Being a compassionate, well-rounded physician and doing well in the basic sciences, and doing well in the medical school pre-req's, those aren't mutually exclusive. You don't do well as a premed and turn out to be a non-compassionate physician. So there's a little disconnect there, but I agree that that's what we want. He said, ‘We should look for budding doctors who dream of caring for patients and spend their college years developing diverse passions. Students who study the injustices of socioeconomic disparities, the intricacies of music theory, or the beauty of poetry can also make great physicians. Yes, yes and yes. Another comment that I wholeheartedly agree with. People who aren't hard science majors, that have experience outside of the hard sciences, are sometimes mostly more well-rounded than those other students. So I agree with that. Those are the kinds of people that we would love to have as physicians.

A lot of what he talked about is the FlexMed program at Icahn School of Medicine. Now I've had Dr. Muller on from Icahn School of Medicine talking about FlexMed. You can listen to that episode all about FlexMed at www.MedicalSchoolHQ.net/16, that was session 16, that was a long time ago. We're at 182, that was session 16. Now FlexMed if you aren't aware, it's a program that Icahn School of Medicine does where they accept students that apply during their second year of undergrad, and if they are accepted they don't have to take the MCAT, they don't have to take some of the upper level science courses that are typically ‘required' by most medical schools. Half of the class is made up of FlexMed students- up to half of the class is made up of FlexMed students. And so he's pointing to the fact that there was a study done by the FlexMed people, by Dr. Muller, that showed that these students who did well in the humanities part of school did just as well in medical school as the ‘traditional' premed students, the ones that were more of the hard sciences. So they do just as well in medical school, and that's great, that's showing that you don't have to be a hard sciences student to do well in medical school. And Nathaniel is basing a lot of his argument on this fact, that you don't- you can be a humanities person and do well in medical school, and I don't disagree with that. And Nathaniel is calling for this change in the premed world, getting rid of these classes, but what he fails to mention, if you go to FlexMed and you look at what they require when you apply, they require a year of chemistry- college chemistry, not AP. They require a year of college biology. They require a semester of physics. Does this sound familiar? You still need the basic sciences to apply to FlexMed, which is a humanities-based program for premed students. So that kind of throws out his argument that we don't need basic sciences. We do need basic sciences, they teach us something, they give us a foundation for what we're going to be learning in medical school, and as we continue to learn as physicians. Now what they don't have is organic chemistry, biochemistry, which okay you learn some biochem in medical school. Organic chemistry, okay maybe because it's a little bit different, more three dimensional thinking, a little bit different, you don't need that. I'll go with that, that's okay. But it still requires those basic chemistry, biology and the other things as well.

Don’t Have to be Hard Sciences Major

So what FlexMed is truly doing, is showing students that they don't have to be hard science majors to go to medical school. And this is I think the key point. This is what we should be screaming from the rooftop; you don't have to be a chemistry major, you don't have to be a biology major, you don't have to be a microbiology major. You can go and major in whatever you want and go to medical school. If you look at the grand scheme of things of the medical school pre-req's, they're just a small portion of the total time that you spend in undergrad. That you have plenty of time to be branching out and exploring some of your other passions, figuring out what else it is that you like that makes you a better human being. Go figure that out. Don't take more of the hard science classes, don't take more of the upper level chemistry and biology classes, you don't need those to be a good physician. You need some basic science knowledge. The chemistry, biology, some physics, that's what being a good premed student is all about. Is learning how to be a good human, a compassionate person, but you need those science classes to be a good physician.

Now I want to take you back, in around the middle of his article he talked about a student- a classmate that was premed with him, and who stopped being a premed, quit being a premed, and he asked Nathaniel, he says, “Why do we have to do this to help patients?” And that's what I want to finish up with here. Is you have to do this to help patients because you have to have a solid foundation to be a knowledgeable physician. You have to have that science foundation. You have to. The key to being a great physician though, as Nathaniel talked about, about being compassionate, and well-rounded, and doctors who can work in teams; that comes from being a good person, not from being a typical- or not typical cut throat premed. That's what I want to leave you with. You have to have that foundation, but being a cut throat premed, competing against your classmates, that's not going to make you a good physician. It's never too soon to start working as a team, collaborating, not competing with your fellow premeds, that's what makes you a great physician.

Final Thoughts

So I'll end with that. If you disagree with what I'm saying, I would like to hear it. Go to www.MedicalSchoolHQ.net/182, leave a comment, and we can discuss this, and I would love to discuss it with you.

If you have any questions, anything else, any suggestions for topics for the podcast, you can always email me. Ryan@medicalschoolhq.net.

I do want to take a minute and thank a couple new reviews in iTunes. We have Drewmelendez who says, ‘Thought provoking and informative.' Thank you for that review.

We have Brainlikeberkeley who says, ‘Very encouraging. I started listening to this podcast about two months ago and there's so much I have learned regarding everything medical school related, especially postbacs, shadowing, and the MCAT.' So thank you for that review, Brainlikeberkeley.

And we have one more here from ClinicalResearcher who says, ‘Phenomenal podcast. The depth and breadth of topics they cover far exceeds any other resource. I highly recommend it for every premed.' Thank you for that, ClinicalResearcher.

If you haven't taken a minute yet to leave us a rating and review, I would love for you to do so. www.MedicalSchoolHQ.net/iTunes. Every time you do that it validates what we're doing here for you, helping guide you on your path to becoming a physician. I encourage you to again, read the article, listen to what I talked about, and let me know what you think. If you agree, if you don't agree, I want to know. I'd be very interested in what you think. Again, www.MedicalSchoolHQ.net/182 is where you can comment on this.

I want to take a second and thank our sponsor for today's show, Gap Medics. Now if you're a high school student or an undergrad student thinking about becoming a physician, one of the best things that you need to do- or one of the best things that you could do that you need to do as soon as possible, is shadow a physician. Figure out if being a physician is really what you want to do. And the experience that you need to do to get that is shadowing a physician. What Gap Medics does is take shadowing to a whole new level by doing shadowing abroad programs. Now their pre-medicine internship programs are a tailored combination of mentoring, observation, and tutorial. They offer a unique insight into the rewards and demands of a medical career. Now not only are you shadowing a physician, but you're traveling abroad. You're learning cultures, you're interacting with different people which makes you ultimately a better person, and in the future, a better physician. They have amazing opportunities in East Africa, in Poland, in the Dominican Republic; amazing, amazing places to travel, and see, and also get that experience that you need to truly understand what life is like as a physician. To know that you're going through this process because you want to, and not just because your parents want you to be a physician, or because you thought it looked cool on Grey's Anatomy. Go to www.MedicalSchoolHQ.net/gapmedics to find out more about how you can apply to one of these amazing internship programs offered by Gap Medics. Thank you Gap Medics for sponsoring The Premed Years. Thank you Gap Medics for supporting The Premed Years.

Alright I hope you got a ton of great information out of the podcast today, and as always, I hope you join us next week here at the Medical School Headquarters and The Premed Years.

The Premed Years, session number 120- 120? I'm way past 120. Let's restart that one.

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