A primary care physician who knows history and can relate to people

by Marianne Mattera

Recently, a press release from Mount Sinai School of Medicine in New York City landed in my e-mail inbox. “Students with Humanities Background Equally Successful in Medical School as Traditional Students”, the headline read.

The press release summarized the findings of a study published in the August issue of Academic Medicine. David Muller, MD, and Nathan Kase, MD, reviewed data on the Mount Sinai graduating classes from 2004 through 2009. The study involved 691 students, 85 of whom were in what’s known as the Humanities and Medicine (HuMed) program.

Kase established the HuMed program in 1987 when he was dean of the medical school and shortly after publication of a report by the Association of American Medical Colleges recommending broadening undergraduate preparation for med school and revamping admissions requirements.

Kids enter the HuMed program in sophomore or junior year of college majoring in one of the humanities, not pre-med or any of the hard sciences. They do not take organic chemistry, physics, or calculus. Nor do they take the MCAT. Admission to Mount Sinai is guaranteed as long as they maintain a 3.5 GPA and get at least a B in biology and general chemistry. After their junior year, students spend a summer semester at Mount Sinai that includes a clinical rotation and some classwork.

Holy cow! Talk about diluting the requirements for a medical degree.

That had to be the sentiment at the time Kase set up the program, and I’m not at all sure the results of the current study will be accepted with any less rancor from the ranks of physicians who did have to struggle through all those mind-numbing hard science courses.

Kind of like the response to shortened hours for residents — “If I had to do it, they should have to do it.”

But do organic chemistry, physics, and calculus make for better doctors? Does the MCAT truly predict success in med school or, even more importantly, in the practice medicine?

Evidently not, according to Muller and Kase. In looking at the 2004 through 2009 graduates, they analyzed knowledge of basic science, performance on a clerkship, humanism, leadership, community service, research fellowships, distinctions, and honors awarded and concluded that the HuMed students “performed at a level equivalent to their premedical classmates.”

Yes, there were some differences, For instance, HuMed students were more likely to have lower scores in Step 1 of the United States Medical Licensing Examination (P=0.0039) and to take a leave of absence (P=0.0001), but they were significantly more likely to “secure a scholarly-year mentored project.”

So, should other medical schools adopt such a program? Will doing so weaken the profession? Make for doctors who lack a solid grounding in the basic sciences?

Well, the HuMed students have to take bio and general chemistry and, let’s be honest, unless you’re going into research isn’t that mostly all you need?

It may be all the country needs right now. HuMed students showed a trend toward residencies in primary care and psychiatry. Although we may not need a lot more psychiatrists, we certainly need more primary care physicians.

I, for one, would rather have a primary care physician who knows history or can argue the relative merits of various political systems and can relate to people than one who aced calculus and can’t look me in the eye or understand why I might be emotionally upset about symptoms that could presage a serious cardiac condition.

Marianne Mattera is Managing Editor at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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  • http://www.ohiosurgery.blogspot.com buckeye surgeon

    Absurd. Why is someone who comprehends the abstract nature of calculus necessarily a cold, indifferent, socially inept clinican? For that matter, why is the author so willing to assume that a doctor who “knows history or can argue the relative merits of various political systems ” is more inclined to be a warm, fuzzy, touchy feely type who will instantly connect with her?

    The leaps in logic in this piece are astounding.

    • anonymous

      The original study didn’t measure clinical skills or ability to relate to patients. It looked at academic performance – clerkships, grades, honors and so on – and concluded that students in Mt. Sinai’s HuMed program *performed as well academically* as students with a traditional, science-based pre-med course of training.

      It’s quite a big leap to infer that science-based training produces people who are nerds, dweebs and social dwarves. You can find dweebs in the humanities too. I think the point is that everyone, no matter their calling in life, could benefit from an education that’s well rounded vs. an education that’s very narrow.

  • AnnR

    Presenting and explaining statistical risk is a big part of health and health care these days.

    Calculus in itself isn’t going to guarantee that. Many history majors get funneled into statistics for social science and that may be adequate although anyone who wants to do significant research is going to need more math.

  • Vox Rusticus

    If they had also looked at a third group, those non-science majoring students who also took the required basic science courses and also took the MCATs just as the other applicants not placed through the special combined program, that might have been even more interesting.

    Medical schools have accepted applicants with non-science majors for decades. Aside from waiving O-chem, calculus, statistics, physics and the MCATs, what is this supposed to tell us? Are they suggesting these things aren’t necessary? Are they suggesting that a medical school curriculum and a much reduced college-level science foundation is enough to produce doctors? Last I looked, there wasn’t exactly a shortage of applicants willing to do things the standard way, regardless of the college major taken.

  • ninguem

    Since when was a student with a non-science undergraduate major considered “nontraditional”?

    I dunno…….if I were sitting on a medical school admissions committee, I think the background that would impress me the most is a stint in the Marines.