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The Arts and Medicine
August 27, 2019

How to Fix the Premedical Curriculum—Another Try

Author Affiliations
  • 1Hartford Hospital, Hartford, Connecticut
JAMA. 2019;322(8):710-711. doi:10.1001/jama.2019.11480

Forty-one years ago, physician-essayist Lewis Thomas proposed that applicants to medical school who were traditional premed science majors be considered last, if at all, for admission.1 Instead, he wrote, preference should be given to students who concentrated on “some central, core discipline, universal within the curricula of all the colleges, which could be used for evaluating the free range of a student’s mind, his [sic] tenacity and resolve, his innate capacity for the understanding of human beings and his affection for the human condition. For this purpose,” he concluded, “I propose that classical Greek be restored as the centerpiece of undergraduate education.”

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    3 Comments for this article
    EXPAND ALL
    Humanities Exposure is Important But No Guarantee of Empathy and Compassion
    Edward Volpintesta, MD | Bethel Medical Group
    I agree that any grounding in the humanities in the pre-med years before going on to the sciences is a good way for physicians to learn how to deal with the emotional and social difficulties that afflict many of their patients.

    Applying empathy and compassion at times are more difficult for physicians than applying medicine or performing a surgical procedure.

    But merely being exposed to the humanities is not enough. Students must have a certain innate capacity and desire to understand the human condition.

    In addition to exposure to the humanities, admission committees would do well
    to consider the importance of this personal quality to the personal interview.

    Much can be learned from the way an applicant engages in conversation, their tone of voice and sense of humor, their range of interests, the books they may have read, their hobbies and even their responses to questions like “what do you think is right wrong with medicine today?”

    After 44 years in practice as a general practitioner I have known physicians who have a great capacity for empathy and compassion and some physicians who don’t.

    And I don’t think that being exposed to the humanities before immersion in the sciences would have made much difference for any of them.
    CONFLICT OF INTEREST: None Reported
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    Fixing the Premedical Curriculum
    Joel Brown, MD | University of Hawaii John A Burns School of Medicine
    Dr Ratzan refers to Lewis Thomas’ proposal to teach premedical students compassion by majoring in the humanities, especially classical Greek language and literature (1,2). Dr Ratzan refers to the Trojan War scene in Homer’s Iliad where Achilles shows compassion by acceding to King Priam’s pleas to return the body of his slain son, Hector. He dwells on the value of reading Greek classics in Greek to learn compassion and empathy.
    We need not learn compassion from ancient literature; just turn a few pages in the same issue of the journal and read Dr WIce’s narrative about confronting his
    wife’s devastating illness (3). We need not read Homer’s story of Telemachus searching for his father, Odysseus, who had not returned from the Trojan War. We can reflect on our own Trojan War--the Vietnam War--and our continuing search for the fathers and sons who have not returned. Thousands of Americans have shed tears of compassion when visiting the Vietnam Veterans Memorial in Washington D.C. Few shed tears when reading ancient Greek literature.

    The Merriam-Webster dictionary defines compassion as “sympathetic consciousness of others' distress together with a desire to alleviate it.” Compassion is an emotion, and humans have variable amounts of this quality. It is unclear if compassion can be taught. Most medical students and young physicians have an innate quality of compassion, a quality enhanced by early exposure to real life experiences, patients, and compassionate faculty role models. Unfortunately, a physician’s sense of compassion can be diminished by the increasing demands of our current medical practice environment, which contributes to the growing problem of physician well-being and burnout.

    The Mount Sinai School of Medicine Humanities and Medicine Program demonstrated that students with humanities majors who omitted organic chemistry, physics, and calculus and did not take the MCAT performed well in medical school and residency (4). Most undergraduate schools require students to select a major after the first two years, which is appropriate for students truly interested in a subject or who intend to enter related specific careers. However, after graduation, many students enter careers unrelated to their major, and many employers favor a broad education. The University of Illinois Chicago’s Bachelor of Arts in Liberal Studies does not require a major field of study, which allows more flexibility in course selection, and could be a model for premedical education (5).

    References

    1. Ratzan RM. How to Fix the Premedical Curriculum—Another Try. JAMA. 2019;322(8):710–711. doi:10.1001/jama.2019.11480.
    2. Thomas L.. Notes of a biology-watcher: how to fix the premedical curriculum. N Engl J Med. 1978;298:1180-1181. doi:10.1056/NEJM197805252982106.
    3. Wice MB. A Difficult Conversation. JAMA. 2019;322(8):727–728. doi:10.1001/jama.2019.11757.
    4. Muller D, Kase N. Challenging traditional premedical requirements as predictors of success in medical school: The Mount Sinai School of Medicine Humanities and Medicine Program. Academic Medicine. 2010;85.
    5. University of Illinois at Chicago. BA with a Major in Liberal Studies. Available at https://catalog.uic.edu/search/?search=liberal+studies&fscaturl=%2Fucat&gscaturl=%2Fucat. Accessed August 30 2019
    CONFLICT OF INTEREST: None Reported
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    Premedical Education:
    Robert Dyson, MD | Retired
    Empathy has nothing to do with whether one has trained in the arts or the sciences. It is built in and we do not have a good way to measure it. Having great empathy for the patient who is dying because you did not have the knowledge and skill to get the diagnosis right the first time you saw them is not an improvement. It really does matter how much a doctor knows. Ability and training is how you get there. The more facts to which you are exposed, the more will be retained and available in recall. Reading Homer is not going to help.
    CONFLICT OF INTEREST: None Reported
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