The Premed Machine
Barrett, Paul M.
The Premed Machine By Paul M. Barrett On a cool spring evening, with mid-terms looming, a Penn premed talks about the kid they call "the Machine": "Unbelievable. He sits down, opens the...
...One-third to one-half of the families had changed doctors because of dissatisfaction over the physicians' personal qualities...
...The problem with this presentation is that students tend to interpret "suggestions" as simply requirements in code: If you really want to get in, kiddo, take genetics, embryology, and immunology...
...At five feet, three inches and perhaps 100 pounds, he's the Dr...
...Crucial equipment disappeared in the dark of night, Sullivan says...
...Business schools instill "the administrative point of view," while law schools teach students "to think like lawyers"-finding legalistic complications in every human setting and marshaling arguments for both sides of a confrontation...
...Foster, is one such marvelous student...
...The practice of recommending additional science courses beyond the basics should end...
...Only the toughest students would survive the brutal training of medical school...
...Everyone is fighting everyone else...
...Every scientist is looking for his wunderkind," says Brutcher...
...Common sense would indicate that more mature people should be choice candidates, especially if they have involved themselves in activities demonstrating humane concerns: community service, the Peace Corps, or public school teaching, for example...
...More important, medical schools must strive for ways to free students from the hysterical premed herd mentality, with its often damaging competitiveness...
...As medicine became more sophisticated, doctors' social status improved, and the profession became far more attractive to top students...
...In fact, the acceptance rate of humanities and social science majors is as high as or slightly higher than that of science majors...
...Johns Hopkins, for example, has for two years admitted some students during their junior year in college...
...One guy had worked on an experiment for five weeks, and then one morning, it was gone...
...Medical school professors became only part-time teachers, committed primarily to their academic work and lucrative specialized practices...
...From crib notes in organic chemistry to Medicaid fraud and fudged results of medical research: the connection may be there...
...The deans and professors took great pride in their new concern for quality...
...There are professors who are anti-premed...
...Worse, the premed culture takes standard-issue high school overachievers and injects them with traits we increasingly complain about in our physicians: narrow-mindedness, cynicism, dishonesty...
...Organic chemistry is the study of how elements fit together and break apart in chemical reactions involving carbon...
...The aim here is not only to permit a premed the time and energy to take up classical Greek...
...She says, 'Dr...
...Paul Elliott of the American Association of Medical Colleges says advisers routinely pay less attention to students who seem to be long shots for admission to medical school, whether it's because they have a few bad grades freshman year or because they are following an unconventional premed curriculum...
...Increasingly, reputations were made on laboratory breakthroughs and development of new technology and surgical procedures...
...So premeds play it safe, generally majoring in science (three-quarters of those admitted concentrate on science...
...Gerald S. Foster, director of admissions at Harvard Medical School, "but the [premedical] thing is often blown out of proportion...
...The percentage of students heavily influenced by their parents' vicarious ambitions must be very high among these young admittees...
...Both argue that students suffer from self-induced paranoia...
...Sabrina Eaton dropped out of the Penn premed marathon after landing an F in freshman chemistry...
...By the end of freshman year, I was a complete wreck...
...But the raw numbers can appear discouraging: in 1983, 212 English majors and 149 history majors were accepted nationally, compared to 5,948 in biology...
...Paul M. Barrett is an editor of The Washington Monthly...
...Epstein, who recovered from his sophomore slump to put together a respectable academic record, hasn't gotten into any of the 12 medical schools to which he applied, although he's on a few waiting lists...
...There seem to be several interrelated reasons why the admissions committees stubbornly maintain this approach...
...Lewis Thomas, head of the Memorial SloanKettering Cancer Center, placed most of the blame for the premed syndrome on the medical school admissions committees...
...No, they don't . . . . In my humble opinion, it's used more as a screening course—that's all!' Brutcher and his academic colleagues see a transcendent beauty in the innumerable patterns of carbon bonds, but little of that wonder filters down to their students...
...But the statistics tell an even grimmer tale...
...That means one B. Seventy-eight on the MCATs [Medical College Aptitude Test...
...At Stanford several years ago, premeds were blamed for staging a bomb threat to buy more time to study for a chemistry exam...
...John Kastor, chairman of the Department of Medicine at the University of Maryland...
...who will tell students: 'lake this because you can get an A. Stay away from this course because it's taught by X, who grades tough...
...We'd be shot to pieces" Brutcher estimates that in a class of 140, he will have 15, perhaps 20, aspiring chemists, engineers, and biologists...
...Now, as then, the medical schools select for good medical students, not necessarily good physicians...
...They refuse to count students whom they won't write [letters of recommendation] for or who choose not to be written for...
...Haagen found that premeds feel greater stress than students interested in other occupations and are more likely to alter course selections and extracurricular activity to improve their shot at med school admission...
...Tito-and-a-half years later, the 300 or so who have survived the grades gauntlet submit medical school applications...
...Because he forgot how to be bored...
...There is some truth in all three explanations...
...Forty-five percent of students who abandoned plans to become a doctor did so because they didn't want to join a profession filled with such grimly ambitious people...
...A brief sketch of the history of medical school admissions requirements helps explain the current situation...
...Timmy Sullivan, a fourth-year student at the Tufts University School of Medicine, recalls that things got ugliest during organic lab sessions...
...But on the other hand, success in organic chemistry doesn't mean a student has much imagination as a scientist, let alone promise as a doctor...
...Cheating is a good case in point...
...By rewarding originality and breadth, Johns Hopkins actually helps improve undergraduate education and sends a direct signal to students that conventional premed strategies aren't the only way to succeed...
...The emphasis on memorizing in premedical education not only can hinder premeds in dealing with human and ethical problems, but it may also hurt them as scientific investigators...
...Billions of dollars in federal aid each year helped finance research facilities and teaching hospitals...
...Third, medical school professors feel a sense of affinity with the premed who may not have broadened himself much in college, but who really beat his brains out in organic...
...But the negative side," she says, "is that it tends to perpetuate whatever premed mold that particular place has decided is appropriate, and people who don't fit into that mold get discouraged very easily...
...Nurturing the nightmare Who is to blame for the premed mess...
...It's a game that can be played different ways...
...However, at least some of her attitudes reinforce the worst aspects of the premed syndrome...
...Among premeds, says a chemistry professor at the University of Pennsylvania, you will find some "true evil ." "It's a feeling like when you look around a big lecture hall," says Dan Guttmann, a senior at Penn, "and you know all these people because they're in all your premed classes, and it's kill or be killed...
...Killer weeds Premeds know the numbers with icy precision: each year 35,000 students apply nationally, and fewer than half get in...
...That was a difficult period to go through" On the outlook of those with whom he has competed for four long years, Schoenfeld says, "There's a feeling you get that some of them think the world owes them something . . . . It does change a fair number of people...
...Again, take cheating as an example...
...What you hear in this grumbling is the faint echo of a chord that grows stronger through the four grueling years of medical school and the 100-hour weeks of clinical internship...
...George Washington and several other schools...
...More complicated is the question of why organic chemistry, among other weeders, continues to dominate the lives of people who have no interest in being chemists...
...Recent developments in medicine make it only more imperative that students entering medical school understand the world from a humane, as well as a technical, perspective...
...Medical schools began to use the exams and courses such as organic chemistry as indicators of applicants' mettle...
...misperceive the nature of the case before them and resort to unnecessary surgery, overuse of drugs, and needless diagnostic tests...
...Ferocious geeks The University of Pennsylvania doesn't "have your Widener Library [Harvard] or your classics [Yale], but we do what we do well—and that's pre-professional," says Frederick Brutcher, who teaches organic chemistry at Penn...
...Most docs are very narrow...
...He has a reputation for having taken no prisoners in the library...
...Many Penn premeds say that they realize they are not well liked as a group by nonscience students and that they miss out on the more pleasurable aspects of college life: namely, exploring new intellectual areas and socializing in a casual atmosphere...
...I had two terrible professors...
...The researchers found widespread cynicism among their subjects, as demonstrated by frequent agreement with statements such as, "People have to cheat in this 'dog-eat-dog' world!' Walking wounded Four years of being a premed takes its toll...
...I got two Cs in bio...
...Yet there is evidence that bureaucratic self-interest may influence the type of advice students at some schools receive...
...Further, he found that about 70 percent of the students who excelled in the clinical sciences had not done well in the basic science area...
...Cheating in medical school may be a predictor of cheating in medical practice...
...But as Kolenik himself admits, even for the marvelous ones, the premed experience fosters extreme behavior that may permanently affect their attitudes toward medicine...
...In their own image The most obvious and powerful causes of the premed syndrome are the medical school admissions committees...
...It doesn't show you have motivation to treat patients" Most doctors are very narrow...
...Officials at the university estimate that out of a freshman class of 2,000, 900 students consider themselves premed...
...It's the common justification for physicians' tendency to be preoccupied with material rewards: I've sacrificed the best years of my life to get that M. D., and I'm entitled to wealth and social status...
...There is also nothing wrong with seeking students with good grades and top board scores...
...Bok noted that many patients who visit primary-care physicians have no physical ailment...
...Membership in a 'premedical society' will, by itself, be grounds for rejection...
...Scientific advances, requiring substantial overhead for laboratory facilities, combined with the spirit of the Progressive Era to close down most of the proprietary medical schools by 1930...
...David Alexander, president of Pomona College, has written about a "grim cycle" in which colleges pressure students to take only the safest routes to professional school: "Admission ratios to medical schools," he explains, "have come to be a kind of institutional SAT for assessing the relative academic success of colleges and universities...
...As a result, premeds take a lot of nonscience "guts"--courses known to be easy As—because they say they need all their energy to survive the weeders...
...Taking a few humanities courses doesn't make a future physician more humane," he notes...
...It's easy to be a little bit calm about it now, but I was nastier then...
...Physicians must have some grounding in general chemistry to understand topics such as biochemistry and pharmacology...
...If premeds didn't have to take organic, guess whose budget would suffer...
...A modified version of the early admission scheme, however, has proved promising at a few schools...
...Since organic chemistry, for example, sorted the men from the boys when it came to library stamina, it remained a key weeding tool...
...Matters outside the domain of science command little attention...
...To qualify for early admission (which eliminates use of the MCAT), students must propose an unusual senior year curriculum of advanced work in the humanities or social sciences, original scientific research, or study abroad...
...Admissions officials respond that they have begun to stress to undergraduates that they desire applicants with broad liberal arts educations...
...But the tendency to exclude students who do not cooperate with the advisers only adds to the frantic rush to join the premed mob as early as possible...
...College becomes a survival test, often dull and demeaning...
...Madeleine Joullie, one of Fred Brutcher's colleagues in the Penn chemistry department, says that students often tell her of premed coaching motivated largely by a desire to put a high percentage of Penn applicants into top medical schools...
...Any college...
...Occasionally, says an AAMC executive, students fake professors' letters maligning classmates with whom they're competing...
...If they can kill off a few quietly, they sort of enjoy it...
...Many students consider a C in organic fatal to medical aspirations...
...The reason for the disparity," says Elliott, "is not that the schools are lying...
...They look at the numbers: the GPA, the science GPA, and the MCAT...
...In a recent column for the student newspaper, The Daily Pennsylvanian, she recounted her family's reaction: " 'What do you mean, you don't want to go to med school...
...You're competing with me for a seat in medical school ." ' This sort of thing happens, oh yes!' The anecdotal evidence, if anything, probably understates the level of anxiety and twisted behavior...
...It can also shut out of the profession many young people who might make exemplary practicing doctors, even though they have difficulty with the arcana of organic chemistry...
...When a student doesn't quite fit the mold, your tendency is not to help him.' Elliott says statistics compiled by the AAMC back him up...
...They arrived at certain predictors [of future academic success] which were heavily emphasized," explains Dr...
...Gert H. Brieger, a medical historian at the Johns Hopkins University...
...Rhoads demonstrated that in his sample of 323 Duke medical students there was no correlation between unusual achievement in basic science courses and excellence in the clinical portion of the medical school curriculum...
...This message plays directly on the premed nightmare of inhuman competitors who study 22 hours a day...
...C. H. Haagen, a Wesleyan University researcher, surveyed the premed scene at several small liberal arts colleges, including Wesleyan, Amherst, and Swarthmore...
...At least I'm into a place...
...Bok added that "through lack of empathy and concern," physicians may "fail to detect these psychological and social considerations [and...
...Anderson does not argue that C students or lit majors necessarily make better doctors than ace biology concentrators...
...The Chicago study demonstrated that although the frequency of student cheating dropped in medical school, the majority of students continued to cheat...
...Instead, the medical schools should encourage students to pursue original research in whatever academic field they desire, with special weight given to projects requiring cooperative work...
...how you function with less sleep than the normal human being gets...
...But the chemists have an interest of their own in seeing organic chemistry retain this role...
...John Kastor entered NYU Medical School at age 26, after five years of working in television broadcasting...
...Brutcher readily concedes the point: "I say to [students], 'I know you come to get two things: a high grade and a good recommendation letter.' " He acknowledges the frustration a research scientist feels teaching students who don't respect his field and, to make matters worse, will probably one day make a lot more money than he does...
...Competition for spots in medical schools heightened in the years after World War II...
...It follows that in admissions, the applicant with straight As in the sciences would seem irresistible to physicians who have spent their careers in academic medicine...
...It's the atmosphere that did it to me," he says...
...Carol Dugan, who advises Penn premed students, receives high marks from students for her enthusiastic interest in their concerns...
...A recent study at Case Western Reserve University found that second-year medical students forget 90 percent of the factual items they learn in lecture courses by the time they graduate two years later...
...This is an open secret, unknown, it seems, only to the premeds who take the course...
...Penn isn't the only school infected by the premed syndrome...
...I've asked many [physicians], 'Do you use organic chemistry in your day-to-day work?' " says Brutcher...
...Have you been taking drugs?' " Although it might not help, there would at least be some justice in forcing such hecklers on the home front to themselves suffer through a year of organic chemistry...
...Grades make the man in premeds' eyes, because that's what they perceive the medical schools are looking for...
...and they keep it hard...
...You take the better bet, which is what other people are doing" According to Dr...
...The kind of knowledge they pump into you doesn't stay in your brain very long," explains Harry Moscovitz, a second-year student at Mt...
...At a large institution like Penn, career planners argue that this assistance is crucial because students have little direct contact with their professors...
...They select people for medical school because they've been through the same thing.' Physicians are at the practicing end of science, and it makes perfect sense for medical schools to admit biology majors...
...And of all the weeders, organic chemistry is the most merciless...
...The chemistry departments claim that, in effect, they provide a service to the medical schools, which use the course as a screening device...
...A cornerstone of the chemist's profession, organic came to prominence in the 1920s and '30s, when new industrial applications were discovered for chemistry and universities expanded their faculties in the field...
...Young people who distrust their classmates, who cheat as if by second nature, who feel the world owes them a lifelong debt of gratitude—these are tomorrow's doctors...
...Medical schools traditionally pay special attention to applicants' grades in certain difficult science courses—the "weeders...
...They select people [for medical school] because they've been through the same thing ." Products of the premed machine favor kids pressed from the same mold...
...You always wanted to be a doctor,' Grandpa protested...
...As a society, we're growing increasingly dissatisfied with our doctors...
...These bodies, generally made up of 20 or 30 physicians, scientific researchers, administrators, and sometimes medical students, hand down the academic standards received by undergraduates as commandments etched in stone...
...But if premeds were encouraged to consider forms of post-college life other than medical school, fewer of them might view the admissions race as a life-or-death affair...
...He wants the next Einstein . . . .The premed has no meaning in my field!' Although he is himself a genial man, popular with his pupils, Brutcher confirms the students' perception that some professors have it in for premeds...
...I knew how to get the As, but with people around you studying like crazy, you just keep at it...
...I see scores and scores of marvelous students" Steve Kolenik, who's on the waiting list at Harvard and would like to hear from Dr...
...According to the group's research, no college has higher than a 70 percent success rate with its medical school applicants...
...You don't know what it's like when you see these huge classes...
...I was probably the most grade-conscious person in the university," Schoenfeld says with a smirk...
...While some major medical schools, such as Penn, say they are reassessing their admissions requirements, others have accepted students before their senior year in college in an attempt to relieve some of the tension in the admissions process...
...Undergraduates, however, react with tremendous cynicism when asked about the medical schools' pronouncements about breadth and variety...
...A study described in a recent Institute of Medicine report on medical education found that 64 percent of a large sample of families were unhappy with their doctor-patient relationships...
...Little need be said about professors who aggravate premeds' misery by singling them out for especially harsh treatment...
...It's that they're only counting the [students] who come through the committee...
...The first step should be for medical schools to require a minimum of essential science courses, and, whenever possible, these should be part of the core curriculum that college students usually must take...
...Fifty-three percent of the 1,065 students interviewed felt many of their peers disliked them, while 24 percent believed their instructors didn't like them...
...Yet research indicates that many doctors overlook significant emotional and cognitive disorders...
...They seemed to enjoy failing people, giving Cs and Ds...
...When I arrived, I lived in Ware College House, which is premeds exclusively," says Steve Kolenik...
...he's a success...
...but many hide in those subjects, insulating themselves from anything not specifically required of them by medical school admissions committees...
...It becomes a habit ." Kolenik, a senior majoring in biology, got into med school...
...The course requires rote memorization of a complex algebra of chemical equations...
...You just pick up that that's the thing to do...
...Likewise, preparation for the multiple-choice MCAT became a major component of premed life...
...Harvard and Stanford are the leaders, Elliott says, although the AAMC refuses to release the exact figures...
...These students take an accelerated curriculum combining liberal arts and medical courses...
...It's full of geeky kids who look at each other and get more geeky...
...According to the American Association of Medical Colleges, hundreds of wildly adulatory letters of recommendation are forged every year...
...Seventy-eight MCATs is not human ." No one goes one-on-one with the Machine...
...But many schools advertise applicant success rates far higher than 70 percent...
...The most disturbing finding," the researchers concluded, was that "there was a continuum from cheating in college, to cheating in medical school in didactic areas, to cheating in clerkships in patient care...
...Phil Schoenfeld, a senior at Penn, has already been accepted by Penn Medical School...
...Of the prestigious career tracks that entice the brightest students on the best campuses, medicine has the greatest impact in shaping undergraduates' lives...
...For a few years they might even dare not to be pre-anything while they read a few books, tool around a bit in the lab, and contemplate the breadth of experiences available out there in the real world...
...Accelerated programs may also push the premed syndrome back into the high schools, starting the hyper-competition at age 15 or 16...
...Medical schools generally favor applicants coming straight from college, says Carole Horn of GW, because "there's a cynical point of view that [the person who's been out of college for a few years] probably wanted to apply to medical school earlier or did apply and didn't get in!' Rather than reward people who gain postgraduate experience and perhaps weigh their applications more carefully, most medical schools question the older applicants' dedication to the profession, Horn says...
...Penn is the perfect place to hear premeds tell their own stories...
...To the specialist-scholars of the great medical research centers, rigid academic requirements affirmed their elevated self-image...
...Caught up in fierce competition for class rank, many students lose sight of the world beyond the library and lecture hall...
...Premeds aren't dumb, says Anderson, just scared...
...J of the premed big leagues...
...Speaking as a premed adviser about my profession," says Elliott, "there's...
...As soon as I got [to Penn]," says Phil Schoenfeld, "I figured I had better get an appointment" at the premed offices...
...maintaining offices for people called 'premedical advisers' will be excluded from recognition by medical schools!' A measure of Thomas's irreverence will be needed to shake up the medical school establishment and improve the education of future doctors...
...There are kernels of truth, individual cases," says Dr...
...As Steve Kolenik puts it, "You wonder whether they mean it...
...Despite the evidence, some people in medical education are skeptical about the extent of the premed problem...
...Norman D. Anderson, dean of admissions at the Johns Hopkins University School of Medicine, premeds have little reason to trust most medical school rhetoric about seeking well-rounded applicants...
...Scott Epstein had a rougher time...
...Brutcher, I'm sitting in the back of the class and I didn't hear what you said...
...Nonscience majors are welcome, say the medical schools, as long as they have fulfilled the basic science requirements...
...Brutcher says that the most common technique is the surreptitious scrawling of key information on lecture hall chairs so that it is available for easy reference during exams...
...If you're not being counseled on med school, law school, or business school, there's a sense that you're being left behind...
...A final result of the premed experience is a strong sense of resentment on the part of some undergraduates...
...For one thing, says Gert Brieger, "it's a lot simpler than worrying about the complicated question of who will be a good doctor...
...at several points, his voice cracks with emotion...
...Schools such as Northwestern and Brown admit exceptionally bright students directly from high school...
...I had another career which I look back on with great sentimentality...
...Second, it's safer: medical schools fear that if they admit someone who hasn't survived labors such as organic chemistry, the student may struggle and possibly fail in medical school...
...I went home for vacation, and I had lost 15 pounds . . .. It just got insane with everyone studying the same things at the same time...
...It's "the course of broken dreams," says Frederick Brutcher of the Penn chemistry department...
...Carole Horn, admissions director at the George Washington University Medical Center, says that undergraduates put through the premed mill have difficulty providing patients with the "trusting, caring feeling people like to get from a doctor...
...Premeds receive little encouragement to begin thinking about topics such as the use of extraordinary life-sustaining techniques, the allocation of scarce medical resources, or the use of prenatal diagnoses in making abortion decisions...
...Professors concede that it occurs...
...He just puts what's in the book in his brain .. .3.98 GPA...
...Regardless of the counselors' rhetoric, there is considerable pressure on students to seek their guidance and affection...
...Paul Elliott, director of student programs for the American Association of Medical Colleges and a former medical school admissions officer and premed adviser, puts it bluntly: "The chemists have it all figured out that the way they maintain their livelihoods at the major university is by teaching premeds, so they've kept [organic chemistry] there as the entry course, the flunk-out course...
...John M. Rhoads, a professor of psychiatry at the Duke University Medical Center, has examined the question of what medical schools get when they admit students who have excelled in the basic sciences...
...He plans to attend a college of osteopathy, a system of quasi-medical physical manipulation based on a theory that diseases are due chiefly to loss of "structural integrity...
...To get an interview, you have to survive the competitive numbers test, which is, as most students assume, heavily weighted toward science...
...Sinai Medical School says that NYU premeds assume that "if you don't get to know [the premed adviser], he won't help you, and you won't get in" Carole Horn of George Washington University defends the need for campus advising services, especially for students from less privileged backgrounds who may need extra encouragement to apply to professional schools...
...Staffed by professional counselors, who usually are not professors, these offices advise students on how to mesh their academic programs with employment strategies in fields such as medicine, law, and banking...
...Acknowledging such evidence, several major medical schools are experimenting with new curricula that stress problem-solving in a small-group setting, rather than memorizing information presented in large lecture classes...
...Admittedly, medical school wouldn't provoke nearly so much undergraduate anxiety were it not for the fear and desperation students themselves bring to the premed drama...
...There are people...
...Motivation was the key," Rhoads explains...
...Premed advisers such as Dugan staunchly deny that they push students to adhere to preconceived standards...
...That such behavior is widely recognized, but continues unchecked at places like Penn, demonstrates the spinelessness of college administrators...
...Undergraduates headed for medical school should be able to blend in with the general student body, where the sense of competition is more diffuse and where they might find themselves interested in a subject just because it is interesting...
...they were weeding us out as if they were working for the medical school or something...
...Brown University, 95 percent...
...encourage applications from older people as another way to undermine the premed syndrome...
...We encourage [the premed syndrome] rather than try to break it up...
...Undergraduates are getting premed from mommy and daddy," says Fred Brutcher, who periodically receives worried phone calls from parents concerned that a midterm slip-up will crush their aspirations for the premed in the family...
...Dare to daydream In his 1978 New England Journal of Medicine article, "How to Fix the Premedical Curriculum," Dr...
...A former New York University undergraduate now in her second year at Mt...
...Clearly, the support of premed advisers helps applicants...
...I guess I'm getting paid back for not doing well my sophomore year," says Epstein, "but I have friends who haven't gotten in anywhere...
...Some are genuinely interested in biology and chemistry...
...There are organic chemists—let me be blunt—who are anti-premed," Brutcher says...
...But whatever pressure this strategy may remove for a handful of students, it has the negative effect of isolating an elite set of smarty-pants who may miss out on the wide range of personal experiences that future doctors should enjoy...
...Not surprisingly, a class like organic brings out the worst in students...
...He proposed a series of fanciful policy changes, including: "Any applicant who is self-labeled as a 'premed,' distinguishable by his course selection from his classmates, will have his dossier placed in the third stack of three...
...Brieger points out that since the advent of strict academic admissions standards, a minority of educators periodically have expressed concern that the doctors were encouraging undergraduates to distort their college curricula to please the medical schools...
...I turned to this guy, and I told him, "I missed what Doc said" He said to me, "I will not tell you...
...Outside of the academic realm, colleges' pre-professional advising offices contribute to undergraduate fanaticism about getting into medical school...
...Someday, the Machine will have an M . D. But you won't be able to get in to see him for months...
...The medical schools often blame the colleges, which in turn complain that it's the medical admissions officials who set all the rules...
...For example, standardized medical school entrance exams—now called the MCATs—gained acceptance in the 1930s...
...He's great, and you know why he's great...
...He doesn't try to understand it...
...An additional benefit of medical schools' admitting more people who decide on medicine later in life is that college students would feel less urgency to declare themselves premed during freshman orientation week...
...While premeds are learning to cheat, they're also becoming narrow, driven people, uncomfortable dealing with others...
...To some degree, these professor-researchers "are trying to reproduce themselves," says Dr...
...Sinai School of Medicine...
...I tensed up...
...Sophomore year it really hit ." Epstein speaks softly...
...Through the early 1900s, most medical schools would admit any warm body they could get their hands on, regardless of whether the enrollee had attended college or had had basic scientific training...
...There's a percentage who do enjoy the power, and if they can kill a few quietly"—Brutcher's voice drops to a whisper-"in my humble opinion, they sort of enjoy it...
...Uniformly required by medical schools, organic is the GPA-crunching monster that haunts premeds on every college campus...
...You look around and you start to be unsure of your abilities...
...A student of medical school policy who has written on the topic, Anderson says that "more than 90 percent of [admissions committees] use some sort of computerized operation to screen their applicant pool...
...I hope I'm a better doc because I was exposed to more...
...Such efforts will not, of course, end competition for spots in medical school...
...In addition to the MCAT, medical schools almost uniformly require about ten courses in basic biology, chemistry, physics, and math...
...As long as everyone can't get in, there will have to be a few tears...
...Doing well in organic chemistry shows that you have motivation for a grade...
...Students describe other, more daring infractions, including circulation of test questions obtained illegally...
...Without the premeds," says Frederick Brutcher, "we'd be decimated...
...He's done advanced lab research and is fascinated by heart surgery...
...Brutcher says out-and-out sabotage is rare, but psychological warfare common: "The girl comes down to the front of the class...
...A recent study of 400 medical students by doctors at two Chicago medical schools revealed that 88 percent of the subjects had cheated at least once while they were premeds...
...But organic chemistry, with its detailed treatment of carbon bonding, has almost no relevance to medical practice...
...He chose medicine because he wants to do something "that helps make people feel better...
...I guess my grades went because of that, even though I was trying to beat the mean like everybody else...
...Probably, that's why we don't get more interesting applicants...
...Sophomore year, I was more confident...
...More subtle links exist between the premed regimen and bad medical care...
...Steve Kolenik describes why a premed would be afraid to major in philosophy and work in chemistry on the side: "You think you'll get behind before you even start, that the science majors will have a head start...
...Most important, the medical schools claim that they seek students who have carefully considered whether they want to be physicians...
...For example, as she explains it, college sounds like a four-year endurance test: "The assumption is that if you can handle these academic and psychological demands at each stage where we put a little more on you, then you'll be able to handle the ultimate demand—when you've got somebody's life in your hands . . .There are connections: How you deal with stress, what kind of confidence you have in your own particular abilities...
...In a 1983 report on problems with medical education, Derek C. Bok, president of Harvard University, also stressed that future doctors are not adequately prepared to deal with the human elements of medical practice...
...He sits down, opens the chem book and doesn't move for 12 hours...
...One of the ways you do that is by being successful in getting students admitted . . . .When a student goes outside you and gets admitted, that makes you look kind of funny...
...Penn, for example, claims 85 percent...
...His conclusion echoes that of Gert Brieger's study of medical school admissions reform in the early 1900s...
...the necessity to maintain your job and your role...
...But by placing overwhelming weight on grades and standardized tests, the admissions committees avoid the difficult problem of trying to choose students who would make good doctors, not just GPA jocks...
...she's crying...
...I explained that just because I'd wanted to be a doctor in fifth grade didn't mean that medicine was my life's calling . . . . Grandpa would not be persuaded . . . . His voice became quiet and grave...
...Derek Bok of Harvard has helped explain the sources of this attitude: In all professions, educational policy is shaped to fit the prevailing self-image of practitioners...
...Medicine has its own notions of what it takes "to think like a doctor...
...In a profession that emphasizes scientifically determined findings," Bok wrote recently, ". . [medical] professors are inclined to impart knowledge didactically, as truths to be described rather than problems to be discussed...
...Richard Ehrle assisted with research for this article...
...On top of that, most schools recommend a long list of higher-level science courses, which students "will find it to their advantage" to take, as the Penn School of Medicine delicately phrases it...
...During the 1910s, a wave of reform swept over the -medical education business, forcing many medical school proprietors to concede that some basic college courses in biology, chemistry, and physics would probably improve their pupils...
...Nevertheless, admissions policies have remained essentially unchanged...
...Tell me the truth, Sabrina...
...Premeds, however, are still put through courses designed specifically to test their ability to retain raw fact...
...Moreover, if their projects require more than a couple of semesters, students may defer entrance to medical school for up to three years after graduating from college...
...It was a question of economics: many of the schools operated simply as profit-making sidelines for doctors, who charged fees for largely unenlightening lectures that purportedly augmented training conducted by means of an apprentice system...
...Sure, they'll take a philosophy major, but you won't be the one...
...They see what's going on when students who are anything but well rounded are accepted, while great humanitarians with glitches in their records get bounced...
...The word gets out to students, who arrive at the sprawling campus in West Philadelphia like pilgrims at the Holy Land, the anticipation of salvation burning in their eyes...
...When a student comes in who doesn't quite fit the mold you know can get in, your tendency is not to help him to find a way to get in, but . . .to say, 'Well, gee, I don't think you're going to make it . ' . . .The bureaucracies of premed advisers are like bureaucracies anywhere else—they can be self-supporting and self-serving" `Speaking as a premed adviser, there's a necessity to maintain your job and your role...
...For me it was perfect," he says...
...Medical educators, says Brieger, "got the idea that by predicting who would be a good medical student, they would also predict who would be a good doctor...
...You get the feeling that no one is on your side...
...The kid does not get bored...
Vol. 17 • May 1985 • No. 4
