This Author Thinks Our Premed Curriculum Needs Overhauled

Introduction

Dr. Ryan Gray: The Premed Years is part of the Med Ed Media Network. That’s www.MedEdMedia.com.

This is The Premed Years, session number 186.

Hello and welcome to the two time Academy Award nominated podcast, 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.

Thank you for joining me again this week here at The Premed Years. I’m very excited about today’s guest. Now I spoke about this guest and an article that he wrote back in session 182 which you can find at www.MedicalSchoolHQ.net/182. The title of his article that was published in Scientific American was, ‘It’s Time to Retire Premed: The existing system of premedical education is broken and needs to be fixed.’ And back in session 182 I broke apart the article that he wrote, and I gave my thoughts, most of them disagreeing with what he wrote. And luckily I wasn’t too mean on the podcast because he was happy to join me here today. And so I’m going to share that conversation with you now. Let’s go ahead and welcome Ned to the show.

Ned, welcome to The Premed Years, thanks for joining me.

Ned Morris: Hi thanks so much for having me.

Dr. Ryan Gray: So you are a recently graduated, recently minted physician. Congratulations on that.

Ned Morris: It’s a little scary, but yeah thank you.

Dr. Ryan Gray: So at this point in your training, with the last four years under you and done with, what can you say- looking at it now, how do you feel now compared to where you went in? Was it everything that you thought it would be? Was it crazier? Was it easier?

Medical School Expectations

Ned Morris: Yeah it’s a great question, I mean it’s always nice to reflect when you get to kind of a milestone. So I think- yeah being at the end of medical school now, I think I’m kind of at a similar aspect that when you’re starting medical school you’re kind of daunted like ‘what’s happening ahead,’ and ‘what am I getting myself into?’ And I’m kind of at that same phase now with residency so I’m like, ‘What am I getting myself into?’ And ‘What’s going to happen with residency?’ But yeah, I mean I think obviously medical school like everything else has its ups and its downs, you have your sleepless nights, you have your triumph moments with patients and things like that, but really taking away from it was yeah, it was absolutely a fantastic experience. I had some of the most incredible opportunities in my life, everything from anatomy lab all the way up to the first time in the operating room and all those things. And yeah, I mean leaving it now I’m absolutely looking forward to residency, and I can’t say enough good things.

Dr. Ryan Gray: What was your draw to get into medicine?

Ned Morris: Yeah so it’s a great question, it’s the typical interview question. I feel like I’m applying again. No so I actually- I was always interested in humanities as well, and I think the opening line for my medical school application said something like, ‘I’m not surprised when people say I should apply to law school,’ because I loved reading about politics, and current events, and writing, and things like that. But I also had seen a lot of aspects of medicine, you know a lot of physicians in my family, and I’d always- actually counter to- we’ll talk about the article, but counter to what it portrays I actually liked a lot of my science classes. And so I was kind of grappling with if I liked the humanities and I liked the sciences, how can I merge these? And I really- I thought a career in medicine is kind of this straight synergy between the two because you get kind of the humanities side of these incredible stories from patients, and talking to people, and learning about their lives. And then you also get the really interesting science aspects with new discoveries, and new drugs, and things like that. And so yeah, it really has worked out and we’ll see how it goes the next few years in residency as well.

Humanities Connection

Dr. Ryan Gray: Yeah, that’s awesome. Talk about the humanities part there and we’ll dig into this article in a little bit.

Ned Morris: Okay.

Dr. Ryan Gray: But from your perspective, somebody who liked humanities and now going through medical school, obviously not out there actually practicing and needing to do this to ‘make a living.’ What is it about being a medical student, and maybe what premeds can take from this as well. What is it about the humanities side that you’re able to connect with, and how can a student get better at that part of it?

Ned Morris: Yeah I mean so there’s a couple angles with that one. So one is especially in admissions and stuff there’s a lot of medicine is about empathy, and being able to sit with patients, and talk with them, and they really allow you into their lives during some of the most private and difficult experiences that they’ll ever have. And so there’s kind of a humanistic, humanities type aspect of learning how to do that. And so we talk about in admissions how much can you teach empathy or things like that, but I think there’s been a real boom especially in the humanities in recent years in medical education. Obviously as I talked about in the article, the MCAT shifting towards psychology and social sciences, more medical schools having arts workshops and things like that, but I think especially in this day in age where the practice of medicine- obviously I haven’t practiced, I’ve only done some internships and rotations and stuff, but from what I’ve seen at least is it’s becoming so computerized and checkboxes and things like that, where there’s all these studies showing interns and residents only spend X number of minutes with patients a day and the remaining hours on the computer. I think patients and providers too are really longing for that human connection again, and for- as I mentioned the stories, and being able to truly value helping people rather than sitting behind a computer and just typing orders and having someone else do it. And so I think there’s real benefit in the humanities, I’m a huge advocate for humanities in medical education whether that be writing, or playing music, or theatre, or anything like that because I think there’s studies- at least people theorize showing how it can combat burnout, and how people getting stressed out in medicine, how that can help. But I also do think it helps you connect with patients. We had a class during my third year which is obviously usually an intense year of medical school where you’re doing your patient rotations, and you’re getting graded, and you’re taking exams. And it was every couple weeks or so but we would sit with our classmates and talk about our experiences. And just that experience of- you don’t think about that as the practice of medicine is being able to sit, and reflect, and write passages about what’s happened. But that was- for me at least it was a huge and important experience because you really reflect on what’s happened, you get to really understand a lot more about your patients when you actually sit down and think about it than if you’re just kind of automated following these treatment algorithms and trying to get home at the end of the day.

Dr. Ryan Gray: Yeah, that’s awesome. What was your- you went to, was it Cornell for undergrad?

Ned Morris: Yeah upstate New York, so nice and cold.

Dr. Ryan Gray: Yeah, awesome. So you go to a great undergrad and then you went to Harvard for medical school. Talk about the journey to obviously a great undergrad and going to probably one of the preeminent medical schools in the country. Was that always your goal or was that just something you reached for and you accomplished?

Journey from Cornell to Harvard

Ned Morris: I mean I don’t know, I think I was absolutely very fortunate. I mean obviously my parents are huge on education, and so I think they always pushed me to my limits of always doing extra credit or things like that, or whatever. But yeah I mean Cornell was an absolutely fantastic school, can’t say enough good things about it despite what you’ll hear in the office and things like that. But yeah it was a fantastic school. The reason I actually ended up picking Cornell is that it’s one of the larger Ivy’s, and so as I mentioned being concerned about humanities versus sciences, when I came in it really had this breadth of offerings. You could take classes in beekeeping, or classes in the history of hip hop, or sciences or whatever, and so that was really attractive to me. And so I showed up and tried a lot of different classes and as I mentioned ultimately decided on medicine. In terms of going to Harvard after, I grew up in Boston so obviously wanting to go home was a nice factor, but then also it’s a really encouraging environment where there’s fantastic students doing exciting things, and yeah you know when students apply you go for re-visits and stuff and you just kind of get a gut feeling of where you’d like to go, and that’s kind of where it worked out for me.

Dr. Ryan Gray: Awesome. What was the hardest thing in your premed journey?

Challenges Faced

Ned Morris: The hardest thing? Ooh, there’s a lot of tough things in premed, right? Yeah I think it’s kind of some of the stuff that I talked about in the article of feeling like- obviously tens of thousands of people do it a year, but a lot of the time when you’re in premed you can feel very alone, and I think that’s a really hard part because sure you’ll have group projects on labs or something like that once in a while, but for the most part with curved classes, and with the intense competition and things like that, you really kind of feel like you’re by yourself, you’re alone, you’re kind of treading water or whatever trying to do the best that you can. And so obviously Cornell had great career resources or whatever, advising services, and a lot of universities have that but I think that’s- I know you took issue with the use of the word dehumanizing in the experience of premed, but I think that aspect of especially when you’re curved and you feel like your interests are- you doing well is counter to your classmates doing well, that often can really isolate you and make you feel alone. And I think that that can be a difficult experience especially when premed is so tough already; if you feel like you’re by yourself, that can make it only harder.

Dr. Ryan Gray: Yeah. Let’s go ahead and dig into the article, we’re kind of skirting around it a little bit. So you wrote this guest blog on the Scientific American platform called, ‘It’s Time to Retire Premed.’ What was the impetus for writing that?

Article: ‘It’s Time to Retire Premed’

Ned Morris: Yeah so it’s an article I’ve actually been thinking about for a long time. I think early in medical school we had read about the Flexner Report which we can talk about later, but that’s Abraham Flexner was this educator with the Carnegie Foundation hired to issue a report basically because medical education back in the early 1900’s didn’t have that stringent standards. People from my understanding at least is that people could pay you to get into medical school, and there weren’t like standard curricula, and schools taught different things, and it wasn’t very science-based. And so he went and did this report saying that, ‘Wow if we really want to train great doctors, they need to have great training in the sciences, and we need to be teaching standard concepts across medical schools, and have strict admissions criteria.’ Which is all absolutely true, but as I said at the end of the piece is that I think we’ve taken that a little bit too far. And I think when I came out of college it was- again, a time where you really kind of reflect and look back and I was like, ‘Wow that was super intense.’ Thankfully I did alright and I ended up at a great school, but just thinking back on how can we improve this process? Especially now that I’ve been closer and closer to practicing medicine, and working in hospitals and seeing how patient care works, you see this kind of disconnect between how we select doctors and then how doctors actually practice on a day-to-day basis. And so I think that’s really why I wanted to write the article, was kind of to just raise the question as to whether we should be rethinking these requirements, and what would be the best way to screen for physicians in the US?

Dr. Ryan Gray: Do you think your perspective is skewed because you went to an Ivy?

Ned Morris: I mean yeah, it’s a great question. Obviously that has some influence on it, right? I can’t generalize my experience at an Ivy League school to somebody who’s premed at a postbac program or a community college or something like that, or even a state school or whatever, even across Ivy’s you can’t generalize, right? So any experience that I derived from premed is going to be different from the vast majority of other people’s, but you know the reason why I thought to write this article, and why I think it would resonate with a lot of people is one, having gone through the process myself, now that I’m in medical school and I have so many friends who are in medical school who came from other schools, you can hear that they’ve had similar experiences. So I thought okay I’m not insane, this is actually happening in other places as well. And then I also sat on the admissions committee for a year with other students at Harvard, and so we got to interview and review applicants. And that was another chance where you’re seeing it from the flipside and you’re thinking, ‘Are these really the traits that we want to have in physicians?’ And so I think both those angles, the common experience of premed as well as seeing it from the other side made me really think about are there ways that we can better approach how we do premed and how people apply to medical school.

Dr. Ryan Gray: Yeah, and if you’re listening to this and you haven’t heard session 182, www.MedicalSchoolHQ.net/182, that’s where I kind of break down and critique this article that Ned wrote.

Ned Morris: Ripped me apart.

Dr. Ryan Gray: Ripped you apart. I’m glad I did it nicely so that we can have you on anyway. But it’s interesting, so let’s talk about it from a point of view- and actually I just want to give my point of view real quick.

Ned Morris: Yeah, absolutely.

Dr. Ryan Gray: So I went to a large state school, University of Florida, and I loved my premed journey. I loved the classes, I loved my classmates, I had a great core group of premeds that I don’t think I would have survived premed without them. And I think that has been the basis for a lot of what I talk about on the show; talking about collaboration, and not competition, and being that kind of anti-Student Doctor Network. And so I had a completely different experience than you did. Granted it was ten or so years ago, how long ago was that? Fifteen? Yeah I don’t even know, I’m old. Anyway so again, and probably a little bit less competitive than it is now, but a completely different outlook. And so that’s where the question is that is it an Ivy thing? Or is it just the state of the union now? Or what is it?

Screening Applicants on the Right Basis

Ned Morris: I think it’s a great point, and so obviously the competition to get into medical school is intense no matter what. I think there was something like 52,000 applicants to medical school last year, and there was only 20,000 spots, right? And so the question I wanted to raise in the column wasn’t should premed be competitive, because just by the nature of more people applying than spots, it’s going to be competitive, right? But the question is whether or not we’re screening people on the right basis, and whether or not the classes that we use to screen people into medical school is ultimately beneficial to patients and to the practice of medicine. And so when we ask does getting an A+ on organic chemistry mean you’re going to be a good doctor?

Dr. Ryan Gray: Absolutely not. I’ll answer that for you, that’s a no.

Ned Morris: Yeah I’m not sure that it does. And so one thing that I took from your criticism of the column is about the importance of sciences, right? And so I think that was one aspect of the column that some people could misinterpret is the notion that we should get rid of all science requirements, and that’s not true. I absolutely agree we need sciences in premed, of course physicians need to know the Scientific Method, and how to read research papers, and how to apply scientific concepts during patient care. The problem is that the current requirements are not necessarily reflective of the kinds of physicians we want to care for us. And so for example would it be more useful for someone who wants to become a doctor is if they take statistics which can also teach the Scientific Method and how to read a research paper, or epidemiology, or psychology rather than maybe organic chemistry or physics. And so it’s not the question of, ‘Oh we need to get rid of all sciences, they’re not important. It’s just are these set of basically four primary classes that we’ve been taking for the last century, are they outdated? Are they completely accurate? Are these the best things that we’re ever going to use to screen doctors? And I think no, I think we should probably re-think how we screen doctors, and we can think of different ways that we can get those important concepts like the Scientific Method across.

Dr. Ryan Gray: Yeah and those four core, you’re talking about biology, chemistry, physics and orgo?

Ned Morris: Yeah, absolutely. And I think you mentioned some schools will also require calculus or mathematics but the general point of those four basic sciences which kind of have formed the foundation of premed as well as most of the history of the MCAT.

Dr. Ryan Gray: Yeah. Alright so let’s go under the assumption that your article is not going to change the premedical education system overnight.

Ned Morris: Oh come on man.

Dr. Ryan Gray: I mean you are a Harvard grad, but I don’t think you have that much power yet.

Ned Morris: Absolutely don’t with that story.

Dr. Ryan Gray: Let’s talk about how the premed that is listening now, what can they do to change their experience?

Changing the Premed Experience

Ned Morris: Yeah so I think in terms of actionable advice, I think that’s what you’re getting at, is a couple things. So one, I think the more people stand up and talk about these issues, I think that’s important because obviously me just writing this is not going to change every medical school across the country saying, ‘Oh now we’ll listen to him.’ That’s not going to happen. But I think there have been columns in the Journal of Medicine, this one in Scientific American, and different venues, and the more people speak up and say, ‘Hey is this really the kind of doctors that we want?’ If premeds are going through this and saying, ‘I want to be a doctor, I want to care for patients, but I don’t understand why I have to know Schrödinger’s equation, or why I have to go over Black-body radiation rather than-‘ and some people might argue, and Shakespeare writing a play, or things like that could also be useful. So I think speaking up is obviously one important thing, but I have the advantage of saying that on the other side; if you’re applying it’s much scarier to say, ‘I’m going to speak up and rage against the machine.’ But I think it should also- people shouldn’t be afraid to branch out from the traditional requirements because I saw a lot of people at least when I was applying who said, “Okay organic chemistry, physics, chemistry and biology; if I’m already taking those to go to med school I might as well just major in biology. Or I might as well just major in chemistry.” And I don’t think you should do that if those aren’t things you want to be studying, right? I think if you’re passionate about those plays that we talked about earlier, about music, or about social activism, or politics, or math, or whatever, I think you should pursue those things because in all honesty medical school admissions committees- sure they’re looking for a great MCAT score, they’re looking for great GPA, but they’re also really looking for someone who’s incredibly passionate about something they’re doing. So I can tell you that if you apply to medical school and you’ve got okay academics or whatever, but then you check off the medical school boxes. ‘I did a couple semesters of research, a couple semesters of volunteering, a couple semesters of shadowing,’ it kind of comes across as is this person just doing this to get into medical school? Whereas if you have someone who is deeply invested in helping underserved communities and volunteers, or started a charity, and did all these different things, that really comes across. And so I would never knock someone who’s thinking of applying to medical school who- sure you’ve got to get through those requirements, and that’s what I’m criticizing in the column, but outside of that I would absolutely encourage you to do as much humanities, or arts, or other things. And people are afraid to do that because they think, ‘If I’m not applying from a biology, or chemistry, or a basic science major am I at a disadvantage?’ And I’d say if you’re passionate about it and you do it well, I think you’re going to be successful.

Dr. Ryan Gray: I love that you used that word- a couple words you used about checking the boxes. I talk a lot about it on this podcast. We talk to deans, we talk to admissions committee members, there is no checkbox. There’s no checklist that says if you do all of these things, you will get into medical school. On the flipside what you talked about is that passion, and I have so many conversations with students, people asking in the Facebook group, people emailing me asking, ‘Is it okay if I do exercise physiology as a major? Is it okay if I do history as a major?’ And my response is always do what you think is going to interest you because when you write your personal statement, when you’re at the medical school for that interview, what’s going to come across is your enthusiasm, your passion for whatever you’re talking about. If you majored in chemistry just because you think it’s what the medical school wants to see, you’re going to have no passion when you talk about it.

Following Passions

Ned Morris: And it really comes across when people are applying too, because if you just list as an activity when you’re applying cycling and you say, ‘I like to bike in my free time.’ It’s like okay, that’s fine, like that’s great that you like biking. But instead if you are really passionate about that and that’s something that’s important to you and you say, ‘I joined the cycling club, and I was a leader in it, and recruited other people, and I did a fundraiser,’ you can tell when somebody’s actually invested in something versus if they’re just listing something to hope that it does something.

Dr. Ryan Gray: I need fifteen, I need to add extra things.

Ned Morris: Yeah a lot of people get into that.

Dr. Ryan Gray: That’s awesome. From your perspective, you said you served on the admissions committee as a student at Harvard; what was maybe one of the biggest mistakes that you saw as the premeds were coming through?

Ned Morris: Yeah, it’s a good question. I mean it’s tough, right? Because there’s no specific checkboxes but yeah, I mean I would say that trying to be passionate about not one thing, but trying to really show that you care about the things that you’re doing rather than as we mentioned just listing different activities. And so if you say, ‘I play this instrument but I haven’t done it since high school,’ or ‘I cycle but I just do it in my free time.’ Like if you haven’t done it in organized settings or been a leader in that, you really should try and show that this is something you’re passionate about, you’re interested in, and that’s probably the major thing.

Dr. Ryan Gray: Let’s kind of steer back towards the article, and what premeds can be doing. We talked a little bit about what the premed themself can do may majoring in something a little bit crazy, what they may consider crazy. What about the interactions with the other students? Because that was a large part of your article, your opening story talking about one of your classmates cheering for the failure of another student basically.

Ned Morris: Yeah I mean so- and you’re calling, you’re saying, ‘Oh I don’t know if this person’s cheering because it’s like ooh, hooray.’ I can tell you that’s absolutely not the case.

Dr. Ryan Gray: I like playing Devil’s Advocate.

Competition amongst Medical School Students

Ned Morris: Yeah I appreciate it, but yeah this person was just like ‘yes.’ And the reason why is in that lab for instance, we were discovering the identity of some mystery powder or something like that, and I’m pretty sure the rule was if you dropped- or like you lost your sample somehow you were automatically docked 25% of your grade for the entire practical. And so basically her dropping that meant that her grade for that practical was down 25%. And so it’s obviously cruel and awful what that other student did, like ‘Oh yes!’ But as I explained later you can kind of understand the motivation, you can say, ‘Oh wow that person literally just benefitted from her misfortune.’ And so as you mentioned talking about collaboration on the podcast and things like that, and I love your optimism in the podcast about how students control the curve or something along those lines, and how if you do well on the test, you’ll do well, and if you don’t do well, you won’t do well. But the problem is that’s not necessarily how the curves work, right? The whole point of a curve is it’s you compared to other people. So I’ve taken tests where I’ve gotten a 90 and get a B-. And I’ve taken tests where I got a 65 and that meant I got an A+. And so I agree that obviously it’s just easy to say try to be collaborative with other premeds and things like that, but a big reason I wrote the column is that things like curves at an institutional level are what breed that kind of cut throat competition because when you put people up against each other, your performance doesn’t depend on yourself as much as it depends on how everyone else does. And so sure, you control the curve in that obviously everyone- if you get 100 every single time you’re going to do better than if you don’t. But at the end of the day you can take the test and know that you got an 85, but you don’t know what your grade is because you don’t know how everyone else did. And I think that’s stressful, and I think that’s why writing the column I thought is this screening for the kind of physicians we want, where you’re thinking about yourself and you’re selfishly like, ‘Oh how can I beat everybody else, and how can I get that better grade?’ I think as you mentioned collaboration and teamwork and maybe working in groups would be a better approach.

Dr. Ryan Gray: There was an awesome research- I don’t know if it was a research study, or if it was just a story that came out of- oh man I heard this on another podcast, and I’ll have to find it and put it in the show notes for this podcast. But it was a story about breeding chickens, and what they were trying to do was breed the biggest, baddest chickens for- I don’t know why they were doing it. And what they were doing was they would selectively pick out the biggest, baddest chickens out of each crop, or each new crop of chickens that came out-

Ned Morris: Artificial selection.

Dr. Ryan Gray: Exactly so there’s this selection bias of these biggest, baddest chickens. And the assumption was that there was going to be like more production of eggs, or bigger meat, whatever they were going for. And what they found was as they were selecting these bigger, badder chickens, the chickens destroyed each other because it was all of these basically alpha males, and I immediately thought of the stereotypical premed when they were talking about this, because that’s what happens, and that’s what you described in your article. And one of my biggest reasons again for doing this podcast, and for doing the episode where I critiqued your article, was that my perspective, again being on this side of it now, and even as I went through it; number one, being on this side of it you can’t be that way because that’s not how you practice medicine. But going through it as well, it didn’t need to be that way because as you break down the data of who applies to medical school, and you talked about it earlier. 50,000 applications and only 20,000 seats so a lot of people don’t get in. But I’ve said it time and time again on here. The students that deserve to get in, the ones that have good grades, the ones that have good MCAT scores, the ones that have taken the time to write a legible and understandable personal statement, the ones that have taken the time to do the extracurriculars, they almost always get in. Almost always. And I talk to a lot of students that I’ll get an email saying, ‘I have a 2.5 GPA and a 19 on the MCAT, and I’m applying this semester, can you read my personal statement?’ I’m just like, ‘Uh no, good luck.’ There are a lot of people that apply like that as well. And so I’m all about collaborating- again, collaboration not competition, and if you get an A and your classmate gets an A, you’re not taking a seat from your classmate and they’re not taking one from you. You’re both taking a seat from someone who doesn’t deserve one.

Ned Morris: Yeah I mean- first of all I’m not sure if that’s how curves work, but I mean second, I think it misses the point of the article, right? Which is that sure, I totally agree for listeners of the podcast if you get a 4.0 and a 45 MCAT or whatever the new scoring system is, you’ll more likely than not get into medical school. But that’s not the point of the podcast is that you’re not going to get in- or sorry not the podcast, the column. The point of the column is that should those people be the ones who get in? Is the person who has the 45 MCAT and the 4.0 who went through organic chemistry and physics, and some things that may not mean that they’re the best doctor. And so even though they’re the shining star who did an incredible job through all of these pre-requisites, does that mean that they should be the person who should be a doctor? I’m not sure. And so I reference that in my article about having friends who I am absolutely confident would have been fantastic clinicians, they are empathic, they’re incredible, they’re such brilliant people. But they start off and they’re like, ‘Yeah I want to care for patients, I think medicine sounds like a fascinating career, and they’re sitting there and they get discouraged because they’re studying atomic orbital theory and it has nothing to do with what they’re eventually going to be doing. So I think in terms of encouraging listeners of the podcast, yeah absolutely. If you do well within the existing paradigms of what you need to do to get into medical school, sure you will probably get into medical school. But the reason for the column was to question those paradigms and say, ‘Is this the right screening tool for who should be getting into medical school, and my answer still is I’m not sure that it is.

Dr. Ryan Gray: If you had the magic wand and were all of a sudden in charge of the AAMC and you were able to dictate to all of the medical schools, ‘this is how you’re going to select students.’ What would it be?

Reevaluating Science Requirements

Ned Morris: Wow I mean- I don’t have the answers. I think the point of the column was obviously to raise questions. I think we should reevaluate obviously the basic science requirements. So as I’ve mentioned again, absolutely we need sciences, we need to teach the Scientific Method, but as I mentioned earlier is statistics, is that better than organic chemistry? I’m not sure but I think it’s something we should think about. Is biochemistry or genetics or any of these better than physics? Those are things that we should think about. Same thing with the MCAT, I’m absolutely thrilled that they recently expanded to more social sciences and ethics and psychology, but still when I talk to people who are applying these days, students spend 90% of their time on their studying, just studying the science concepts and not other- I guess I would definitely promote continuing those shifts, I’d love to see more programs like the humanities and medicine program and Mount Sinai which I referenced at the end of the article, which is the-

Dr. Ryan Gray: That’s FlexMed.

Ned Morris: Yeah FlexMed so it’s the early decision program where you take kind of a variation of the premed requirements. I think all those would be important. Another thing that I didn’t get a chance, obviously with column space you get limited, but to bring up is kind of the idea of evidence. Medicine in the 21st century is very evidence-based. You give treatments on the basis of research, and data, and evidence-based guidelines. But it’s been decades of these premed requirements and we don’t really have that much evidence to suggest people who do well in these basic science pre-requisites are better medical students or doctors than people who do well in some of the sciences and some other classes. There might be studies out there saying, ‘Okay your GPA and MCAT,’ sure that’s a better predictor, but I think explicitly comparing the traditional basic science requirements versus a variation, we don’t have that much evidence. And I even cite that one study of the faculty at Mount Sinai who compared the FlexMed students to the non, and they found overall- there were some variations, but overall they performed pretty much the same. And so if we’re going to tell ourselves that medicine is an evidence-based profession, and we’re going to screen people into this profession where the practice of medicine is evidence-based, it’s strange that we’re recruiting the next generation of physicians based on a century old paradigm that hasn’t been tested and researched.

Dr. Ryan Gray: Yeah and I had Dr. Muller on way back in session seventeen over two years ago.

Ned Morris: The beginning.

Dr. Ryan Gray: Actually session sixteen, sorry. And we talked about FlexMed, and I’ve wanted to follow up with him and I think one of the things that we talked about in that discussion, in that podcast episode was exactly your point. How are we going to look at this from an evidence standpoint? And the gold standard should be, in my opinion, patient outcomes. It shouldn’t be board scores, it shouldn’t be MCAT scores which is kind of what- or not MCAT, the board scores.

Ned Morris: Step one or step two.

Dr. Ryan Gray: Yeah board scores and pass rates and all of that. And that’s kind of the data that they’ve been using to compare the science and non-science students.

Ned Morris: I totally agree that patient outcomes in terms of who can treat patients better, and also obviously it’s subjective, but patient satisfaction scores. So that’s an important element. One- just for listeners, the different outcomes would be if the patient comes into the hospital with pneumonia in terms of mortality or morbidity et cetera thirty days later, how well are they doing? So that’s a measure of outcomes; how well do you treat that patient? But then in terms of- sorry I lost my train of thought. Outcomes versus- what was the other thing we were talking about?

Dr. Ryan Gray: I don’t know.

Ned Morris: I lost my train of thought there, sorry about that.

Dr. Ryan Gray: Board scores, and outcomes.

Ned Morris: Board scores, oh sorry satisfaction scores.

Dr. Ryan Gray: Alright there we go.

Patient Satisfaction Scores

Ned Morris: So yeah outcomes is treating the patient, but satisfaction scores is how- what was the experience? And that more readily measures bedside manner. How polite was the person? How professional were they? How comfortable did the patient feel with them? And those are really difficult things to measure, right? So it’s much easier to compare step one scores or whatever, and that’s what they use a lot in that study. But I totally agree, is how much are these classes, or how much of these recruiting tools are teaching paradigms benefitting patients? That would be the ideal, right? And that’s one thing that bothers me when I talk about the debate about reform in premed is when people say organic chemistry or physics or some of these classes referring to the vague notion of critical thinking skills, right? And a lot of people say, “Oh critical thinking and other vague notion- it makes you a better thinker.” And I think there’s two problems with that. First I’m not sure there’s much- how do you prove evidence that organic chemistry makes you a better critical thinker than does statistics or something like that? And second it’s sort of insulting to other careers too because it’s like, ‘Oh you don’t develop critical thinking skills because you only took economics, or you only took mathematics, or whatever.’ So I think a lot of people agree, going to college hopefully you become a better thinker, and more accepting of world views or whatever. But I don’t buy that argument a lot when people say, “Oh premed, we need these science classes because they make you a better critical thinker.” My first thought is okay where’s the evidence? And the second thought is other classes definitely do as well.

Dr. Ryan Gray: I’m thinking back to my episode I did, and wondering if I said that, too. If when I was critiquing your article if I said we need that for critical thinking.

Ned Morris: I’ll take a listen after.

Dr. Ryan Gray: Uh oh. I’m worried now. Yeah, I agree with your point that you can be a critical thinker in the humanities, and it has nothing to do with science itself.

Ned Morris: Yeah.

Dr. Ryan Gray: Awesome. Ned, thanks for this discussion. Any last minute pearls of wisdom for the premed out there struggling with their classmates?

Advice to the Struggling Premed

Ned Morris: Wow, yeah. Keep at it, it’s an absolutely profound experience to be able to care for patients. So I think it’s hard to keep sight of that light at the end of the tunnel, right? And that’s why hopefully people will stand up and talk about changing the tunnel and reforming what premed is like. But for the person who’s struggling out there and doubting themself I’d say you can get lost in the problem sets, and the curves, and all those things that obviously we’d love to change institutionally that take time. But take a step back and think about what you want to do when you’re older, think about what makes you happy, and yeah I think that’s why volunteering and shadowing experiences can be helpful. You can see what the practice of medicine is like because yeah, there really aren’t that many other professions in the world where you do just get to sit down with someone you’ve never met for the first time, and they basically open up their life- every aspect of their life to you that even maybe their spouses or their closest confidantes don’t know. And that’s a really extraordinary privilege, and yeah I’m absolutely thrilled to be starting residency and hope some teacher colleagues are listening to this as well.

Final Thoughts

Dr. Ryan Gray: Alright I think we got to the heart of it of what Ned was trying to get across in his article title, ‘It’s Time to Retire Premed,’ again, Scientific American blog. And again the links to that will be in the show notes, www.MedicalSchoolHQ.net/186 for this podcast episode.

I think we both agreed that science is still a key factor in education for physician but there’s lots of room for improvement in other classes, other opportunities to teaching the Scientific Method, and teaching statistics, teaching how to read research instead of just taking the organic chemistries, the biochemistries, whatever else. So lots of great discussion, thank you Ned for taking the time to come onto the show. Ned is on his way to UCSF for psychiatry, so good luck to Ned in the future with everything that he’s doing.

I do want to take one second and thank the several people that have taken the time to write in and give us ratings and reviews in iTunes.

We have Johnny8D who says, ‘The lighthouse in the premed fog.’ I just love that visual, that’s an awesome visual. Johnny8D says, ‘There’s a lot of contradicting info out there and as a transfer student from a community college that didn’t have a great premedical support system, The Premed Years is a godsend.’ Thank you Johnny8D for that review.

If you would like to leave us a review go to www.MedicalSchoolHQ.net/iTunes. That’s the best place to leave a rating and review for us. We have xRetna who says, ‘Recommended to all. This is by far the best podcast series I’ve listened to.’ Thank you xRetna for that.

And we have one more here from Kate R.N. who says, ‘Love this podcast. I’m a nontrad registered nurse making the jump to start medical school in August. This podcast has been very informative as I contemplate the changes to come and work to set myself up for success.’ Thank you Kate R.N. Good luck on your journey and maybe we’ll have you on the show to talk about your journey from nursing to medicine.

Again www.MedicalSchoolHQ.net/iTunes if you would like to leave a rating and review.

I do want to encourage you if you haven’t yet, go check out www.MedSchoolInterviewBook.com. Now as we’re publishing this on the 15th of June, 2016, we have about a month until the Premed Playbook, Medical School Interview Book comes out. Now if you go over to www.MedSchoolInterviewBook.com you can sign up to be notified when we get that book ready to ship out on Amazon. It will be on Kindle and you can get a paperback through Kindle as well. I’ve told some people that this is probably the hardest project I’ve ever worked on, maybe outside of medical school, and it’s a grueling process but a fun one. And so I highly recommend you go over there. I’ve had Dr. Polites who’s been on the show a couple times, he does some admissions stuff at Wash U, he runs a premed program at Wash U for the undergrad kids; I had him read it and got a glowing recommendation from him. So I know it will be very valuable for you as you prepare for your interviews. Again www.MedSchoolInterviewBook.com.

Well 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 podcast.