EDITORIAL

Science for Future Physicians

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Science  05 Jun 2009:
Vol. 324, Issue 5932, pp. 1241
DOI: 10.1126/science.1176994
CREDITS: LINDA CICERO, STANFORD COMMUNICATIONS, STANFORD UNIVERSITY; TERRY DAGRADI

Biomedical research is rapidly transforming our understanding of health and disease, with major implications for medical practice. But the science education of physicians has not kept pace with these advances. Today, the Association of American Medical Colleges (AAMC) and the Howard Hughes Medical Institute release a report that addresses this issue.* The analysis, by a committee of U.S. undergraduate and medical school faculty that we co-chaired, comes 6 years after the U.S. National Academies report BIO 2010, which noted that undergraduate premedical course requirements and the content of the Medical College Admissions Test (MCAT) constrain innovation in undergraduate science education.

The new report, Scientific Foundations for Future Physicians, emphasizes that physicians must have a firm grounding in the biomedical sciences and understand their relation to the physical sciences and mathematics. For physicians to be prepared for inquisitive, critical thinking and lifelong learning, they should also be able to incorporate the methods of science into their practice, including skeptical and critical analysis. These goals should be reflected across the entire span of a physician's education, from undergraduate study through medical school.

Medical school faculty have a short time in which to convey an in-depth understanding of specific medical knowledge and recent research. Students should arrive at medical school prepared in the sciences, including some areas not currently required, such as statistics and biochemistry. If all beginning medical students understand general biochemistry, for example, then faculty can build on this knowledge, creating more opportunities to explore the synergistic relationships among biomedical science, research, and clinical medicine. Medical schools should also increase their emphasis on the importance of the physical sciences and mathematics in biomedical research and clinical practice.

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How should preparation for medical study be assessed? Medical schools generally determine scientific readiness for admission by course requirements and scores on the MCAT, which mainly reflects the traditional content of those courses. In contrast, medical schools have long evaluated readiness for medical practice in terms of competency—specific learned abilities that can be put into practice—rather than by mandating standard courses and curricula for all medical schools. The report recommends that scientific readiness for medical school entry be assessed similarly: The current list of required premedical school courses should be replaced with required science competencies. Instead of a nationwide requirement that premedical undergraduates take specific chemistry classes, for example, a required competency might be described as being “able to apply knowledge of the chemistry of carbon compounds to biochemical reactions.” The report suggests competencies for premedical and medical school science education, recognizing that there may be multiple routes to gaining a competency. An integrated approach to both undergraduate and medical education may help both to innovate.

A change in competency-based educational goals would allow undergraduate institutions the option to design new curricula. Chemistry competencies, for example, might be gained either in traditional chemistry courses or in rigorous interdisciplinary courses. Such innovations, aimed at increasing relevant scientific content and understanding, should also yield more efficient teaching. While recommending new competencies such as biochemistry and statistics, the report's committee opposes a net increase in premedical science requirements. As the report states, “the undergraduate years should not be designed primarily to prepare students for professional school, but for creative engagement in a broad, intellectually expansive education.” In conjunction with the shift to competencies, the MCAT could be modified to test for competencies proposed by the committee. The new report coincides with an AAMC review of MCAT content, a multiphase process that will consider the report, among other inputs.

In a system with so many participants, dialogue is essential to progress. Outreach to and feedback from the scientific disciplines and medical community will enhance the success of these efforts. We urge colleagues to engage in this national discussion.

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