COLUMN: Training doctors with hearts for the 21st century

From Nadia Dowshen's, "Urban Guerrilla," Fall '99 From Nadia Dowshen's, "Urban Guerrilla," Fall '99When I received my acceptance letter to medical school in the mail I literally jumped around my room with joy. At that moment, all of the studying and sacrifice seemed worth it. However, the initial surprise and excitement wore off quickly as I began to seriously reflect on the pre-med experience. The required undergraduate curriculum for medical school and the pre-med culture at Penn make me worry that we will turn out the wrong kinds of physicians for the 21st century. Changes in health care mean that doctors must be prepared to earn lower salaries and work as part of a team under managed care rather than individually running a private practice. Students need superior problem-solving skills and the capacity to work productively with others in order to prepare for this kind of career, in addition to basic science knowledge. Many professors fail to teach these important skills and some courses implicitly teach the opposite. The bell curves that many basic science professors use are a major factor in encouraging competition. Also, many basic science instructors grade pre-med students more harshly or teach with pre-med classes with an attitude. Some do this because they assume, unfairly in many cases, that students only take the class to get the grade or because it is required and have no interest in the subject matter. And we have all heard stories about the Penn pre-med who steals a classmate's notebook the night before a test or sabotages another student's experiment. Regardless of the truth of these stories, even the best of us understand what could have driven somebody to these extremes -- the need to beat the mean. Of course, some professors do teach pre-meds important skills, attempting to create a less competitive environment where students can learn more. For example, one of my organic chemistry professors emphasized general problem-solving skills on exams rather than relegating us to memorizing obscure mechanisms that not even real experimental chemists use. This professor also encouraged us to work together to learn the material and rewarded us for helping each other by grading based on the entire class' performance rather than using a set distribution. We found him available to answer questions at any time of the day or night -- either via e-mail or personally in his office -- and he always treated us with respect. These are the kinds of teachers we should expect for the high tuition we pay. Perhaps more importantly, such teaching will help produce a better pool of doctors. When professors encourage cut-throat competition, they should remember that they may one day entrust their lives to these same students. But even good teaching doesn't remove all the barriers prevent students who would make excellent physicians from even applying to medical school. The cost of preparing for and taking the required Medical College Admissions Test -- plus application fees and travel costs piled up getting to interviews -- generally totals several thousand dollars. And only students who demonstrate great financial need are eligible for fee waivers. Throughout coursework and preparation for the MCAT at a large school like Penn many minority, financially needy and educationally disadvantaged students slip through the cracks and do not get the extra support they need to make it through such a competitive process. Penn faculty and administration must support and encourage pre-med students who will make the kinds of physicians they would trust to take care of their own families. The university's pre-med curriculum and advising program should prepare students both scientifically and morally for careers in medicine. And extra efforts must be made to ensure that students who show promise do not get left behind because of discrimination or the size of their parents' pocketbook. I am still every bit as excited about medical school as when I first opened that acceptance letter but I can not help thinking about how many incredible potential physicians the medical profession has lost due to the pre-med culture and curriculum.