Relevance and rigor in premedical education.

n engl j med 359;3 www.nejm.org july 17, 2008 221 changes have occurred in medical practice and health care delivery. In the face of these new realities, medical school curricula have had to adapt. Yet despite these sweeping changes, including the permeation of most areas of medicine by molecular and cellular biology and genetics, requirements for admission to medical school have remained virtually unchanged for many decades. Ironically, though many of today’s high-school students are learning advanced science and mathematics that my generation studied in college or medical school, U.S. medical schools continue to devote precious time in the preclinical years to elementarylevel biochemistry, cell biology, and genetics. With so much new scientific material to cover, medical school faculties must struggle to fit it all in while addressing the needs of students with widely varied levels of science preparation. Pressure on faculty members teaching preclinical courses is intensified by the truncation of the preclinical program at many medical schools to allow for earlier entry into the clinical curriculum. At the same time, many medical schools, recognizing the value of student scholarship, are adding a requirement for an in-depth scholarly project that must also fit into a 4-year curriculum. Some view the current premedical science requirements — 1 year of biology, 2 years of chemistry (especially organic chemistry), 1 year of physics, and, in some schools, 1 year of mathematics — as a necessary gauntlet that thins out the applicant pool. Unfortunately, current college courses that fulfill admissions requirements are not adequately focused on human biology; the topics covered in many courses in chemistry, physics, mathematics, and even biology are so removed from human biologic principles that they offer little value to the premedical — or advanced human biology — student and steal time and attention from more relevant science preparation. Does a student, for example, really need a full year of organic chemistry to prepare for the study of biochemistry? Moreover, premedical science courses often fail to achieve sufficient rigor to prepare stuBecoming a Physician