Yale School of Medicine Dean Calls for Broad Changes in How Future Physicians are Educated

In an effort to transform medical education and bring it into line with 21st century scientific knowledge, Yale School of Medicine Dean Robert J. Alpern, M.D., and Sharon Long, Ph.D., Dean Emerita of Humanities and Sciences at Stanford University, co-chaired a committee of renowned scientists and physicians who are calling for a major overhaul of undergraduate premedical and medical school curricula.

Their report, entitled “Scientific Foundations for Future Physicians,” is being issued on Friday by the Association of American Medical Colleges (AAMC) and the Howard Hughes Medical Institute (HHMI). The 22-member committee recommends that premedical education should change from a static list of mandated courses to a curriculum that focuses on acquiring a set of core science “competencies.” The committee defined a competency as the knowledge, skill, or attitude that enables an individual to learn and perform in medical practice.

The committee felt strongly that future physicians must be equipped with a strong scientific foundation and the ability to integrate new scientific discovery into the practice of medicine throughout their careers. Committee members believe that the entire span of a physician’s education, from undergraduate study through medical school, should reflect preparation for inquisitive, critical thinking, lifelong learning, and the ability to incorporate these traits into their practices. Toward that end, they identified eight scientific competencies they believe should be mastered prior to medical school and eight others, focused on the natural sciences, that all medical students should demonstrate before receiving their medical degrees.

In an editorial in the June 5th issue of Science Magazine, Alpern and Long summarized the committee’s view that the undergraduate scientific education of physicians has not kept pace with research advances. They expressed the concern that current pre-medical course requirements have constrained innovation in undergraduate science education and discouraged talented students from pursuing a career in medicine.

The committee recommends giving undergraduate educators more flexibility in developing interdisciplinary and integrative courses that maintain scientific rigor, while providing students time for a strong liberal arts education. For example, students would be expected to know how “to apply knowledge of the chemistry of carbon compounds to biochemical reactions” rather than take specific chemistry classes. Likewise, instead of requiring specific mathematics courses, medical schools would expect applicants “to show competence in applying quantitative knowledge and reasoning and informatics tools to diagnostic and therapeutic clinical decision making.”

The committee recommends changing the educational system so that students arrive at medical school better prepared in certain scientific competencies not currently required, such as statistics and biochemistry. It suggests, too, that medical schools increase their emphasis on the physical sciences and mathematics in biomedical research and clinical practice.

“Medical schools should be able to spend less time teaching or reviewing basic competencies, and more time on the ever-changing base of scientific knowledge needed to practice modern medicine,” said Dr. Alpern. “Rather than increasing the number of requirements for undergraduates, we propose substituting more relevant requirements for those that have become less relevant to the practice of medicine.” According to the report, “the undergraduate years should not be designed primarily to prepare students for professional school, but for creative engagement in a broad, intellectually expansive education.”

The report’s findings will be considered, along with other initiatives, in the AAMC’s comprehensive review of the Medical College Admissions Test (MCAT), an assessment of a student’s readiness for medical school, which is currently under way. In addition, a separate report on the behavioral and social science competencies for future physicians is expected in late 2010.