Should humanities be the focus of prospective medical students?

There’s been considerable buzz on the web recently – on the New York Times website, on Facebook, and on a physicians’ forum called Sermo, at least – over a New York Times article recently entitled, “Getting Into Med School Without Hard Sciences.”

The article describes the Humanities and Medicine Program at Mount Sinai Medical School, a program which each year admits into the medical school 35 undergraduates who major in the humanities or social sciences and can maintain a 3.5 GPA.

Dr. Nathan Kase, who founded the program, said, “The default pathway is: Well, how did they do on the MCAT? How did they do on organic chemistry?…That excludes a lot of kids, but it also diminishes; it makes science into an obstacle rather than something that is an insight into the biology of human disease.”

Students in the program, who apply during their sophomore or junior years of college, can forego taking the MCAT or physics, organic chemistry, and biology during college but do have a “boot camp” in those subjects at Mount Sinai prior to beginning their medical studies. A study published in the Journal of the AAMC entitled “Challenging Traditional Premedical Requirements as Predictors of Success in Medical School” has reopened the sometimes vitriolic debate over whether the traditional requirements should be revised or whether they are even necessary.

This discussion is not new; essayist Lewis Thomas, while defending the vital importance and inherent wonder of scientific learning, wrote about the need for more well-rounded physicians and published an essay entitled “Humanities and Science” in his popular work Late Night Thoughts On Listening to Mahler’s Ninth Symphony. Many medical schools around the nation have included “humanities and medicine” curricula as part of their med students’ training.

Most physicians who were science majors have of course come out in passionate defense of tradition, with some showing embarrassingly arrogant contempt for their counterparts in the humanities. They have called the Mount Sinai program an example of the “dumbing down” of American education, which I find patently offensive as a former English major who chose one of the most science-oriented specialties in medicine (but also, to my mind, one of the most artful).

I value what I learned in biochemistry about molecular pathways and receptors and in physics about pressure gradients and flow, but I also know that my training in the humanities contributed to my intellectual skill set in ways my science classes could not. I can think critically, listen to and interpret stories, write a narrative, learn foreign lingo, diagnose conditions based on various clues and signs, analyze situations, and make critical decisions because of the riches I gleaned from strong training in both the sciences and the humanities.

I still remember a surgeon who once answered a patient who was surprised she hadn’t read a particular Shakespeare play, “Well, I spent my time reading things that would actually be useful to you for this operation.” I find this attitude to a sound literary education small-minded and cheap. People without imagination so often focus on what is considered visibly “useful” without considering the intangible good done by less pragmatic knowledge. I was taught by some of the best teachers in the world that understanding a character or a line of poetry is not fluff compared to deriving an equation but rather a crucial component in the working of the mind and its interaction with the world.

During my training I was once asked in front of a patient to recite some respiratory physiology equation which, to my patient’s approval, I was able to do easily at the time. But I wanted to say to the attending physician, “Ask me, too, what this patient’s story is. I can tell you because I listened. I can tell you because I can put together and recreate a good narrative. And in the end it will help me take better care of this patient than knowing that equation.” Good patient care is and, for me, always has been about story and relationship as well as facts and figures. We have to be able to do well working with both.

I find the habit of many physicians of looking down at the humanities and humanities students completely obnoxious, but of course, I am biased. I happen to think I’m a better doctor for having been well-educated one, with multiple aspects of the mind trained and challenged – not just the ones that can distinguish between an ester and an amide.

Anesthesioboist T is an anesthesiologist who blogs at Notes of an Anesthesioboist.

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  • http://obcookie.blogspot.com Elizabeth

    Thank you for this lovely post. I too had a diverse liberal arts education before medical school. Now that I am a resident, I am so grateful for the liberal arts training I had. Not only has it given me a critical eye and a different world view, it has made my limited free time rich. I think that being able to read, write and analyze well is much more important than any chemistry that I learned and have well forgotten.

    • http://www.twitter.com/alicearobertson Alice

      Not only has it given me a critical eye and a different world view [end quote]

      Hi! Hmmm….at times it’s the worldviews that concern me. I have taught literature classes, and can get a bit passionate about the topic (I blogged about literature helping me get through my daughter’s cancer diagnosis), but my favorite doctor said he hasn’t read a novel in so long because of the constant research he is involved in. He can’t quote Shakespeare, but there is no other doctor we would rather have. He is in no way small minded and wins big research awards, and really believes he is helping people (and he is).

      I believe the worldview taught at the bulk of universities helped usher in this administration, and overall we got what we paid for…..liberal thinkers under a humanitarian guise. That’s why your honest statement caught my conservative eye:)

  • Dan

    Interesting post, but I must say that most hard science students are much better versed in the humanities than humanities students are in the sciences.

    • SH

      Dan – this may be true of your average college student population, but is an inaccurate assessment of the group of humanities students entering into the medical profession. We are well-versed in both because we need to be.

  • Mark

    This Mount Sinai program is a scam, just another way for rich, well-connected people to take valuable medical school spots without having to compete on an equal playing field with the rest of us.

    “About a third of the [Humanities and Medicine Program] class had at least one parent who was a physician; among all medical schools, about one in five has a parent who is a doctor. [One student's] mother and uncle are doctors at Mount Sinai; her father, Robert Friedman… is on the Mount Sinai Medical Center board.”

    “admissions heavily favor elite schools”

    There is nothing that says you have to be a science major to get in to medical school. You can take the required science classes as electives during undergrad, or in a post-bac program. The admissions boards are very, very open to nonscience majors. And the nice thing about the system is that it doesn’t matter if you were lucky enough to go to a fancy high school or college, or whether or not your parents are on the board of the medical school. If you work hard enough to get good grades and score well on the MCAT you’ll have a good chance of getting in.

    Medical school spots are valuable commodities that students dedicate years and years of work to achieve. This program is just a way for the upper class to take some of those spots without putting in the work.

  • Earl

    I still want an MD who can do organic chemistry and physics AND read and write in English +/- other languages. A surgeon who can play the piano. A psychiatrist who understands that there is no such thing as H+ in aqueous solution. A pediatrician who reads Somerset Maughm and a cardiologist who bakes chocolate cakes and an immunologist who runs marathons. In short, I want only the smartest, hardest working, most well-rounded and interesting people to get into med school.

  • Kevin N.

    I certainly don’t see how it could be considered a ‘short cut.’ These students will still have to pass all his or her USMLE and/or COMLEX step exams. If they’re able to (1) pass med school coursework and (2) pass step i-iii, then perhaps an argument should be made about the necessity of the undergrad prereq’s in the first place?

  • http://fertilityfile.com IVF-MD

    Just because one does not take humanities in college does not mean that one does not expose himself/herself to the humanities.

    To learn organic chemistry and physics, the best source of unbiased information might be your college professors. This is probably because it’s hard to inject political biases into how to synthesize an epoxide out of an alkyl halide or how to calculate centripedal force. However, with regards to economics, politics, history and literature, widening your scope of learning by being open to sources from the entire world sure beats the pants off of relying solely on what is fed to you via the party-line course syllabi or assigned textbooks. Sure this is just my strong opinion. I could always be wrong :)

    By the way, I was a social sciences major, but that’s besides the point.

  • ninguem

    A hitch in the Marines would impress me more than whether the undergraduate major was science or humanities.

  • jenga

    We all know that the first two years of med school is all about learning mass quantities of complex scientific data. It is a sound hypothesis if students can’t handle such classes, that they will struggle with 10 times the material and as or more complex material the following year. I don’t think it is too much to ask to continue as is. Tell me exactly where do you stop this exactly. A psychiatrist doesn’t use gross anatomy. Why should they take it? Does a radiologist have much use for microbiology? Some could say I want to go into Geriatrics why do I need OB? I don’t want to see kids in practice, why do I need a pediatric rotation? We have to have rules and standards that everybody plays by and if we are going to chunk those. Why have a MCAT? Why have a USMLE? Why have a Board exam?

  • jenga

    This is nothing more than a game of moving the goalposts. Organic chemistry may make it an obstacle and is that a bad thing? Before someone chucks down a couple of hundred grand and 7 plus years of their life, requiring them to take some science classes is a pittance of what they are in for. Taking such classes shows commitment and that their plan to be a physician is not on a whim. We shouldn’t let people into med school just because they saw a really moving episode of Grey’s Anatomy.

    • Dan

      Also, I think it is more fair to students to have a significant benchmark early in their academic careers. Organic chemistry was when a decent number of people realized they didn’t have what it takes. Leading these people on until the end of college when they take the MCAT is not good.

  • jsmith

    Let’s look at the numbers. Four years at a semester school at 16 units per semester equals 128 units if you’re going full-time (and if you want to get into med school, you’d better be going full-time). Typical Med school requirements: 8 units of calculus , 8 units of general chemistry, 8 units of organic chemistry, 8 units of biology, 8 units of physics =40 units, leaving 88 units for Shakespeare or Vergil or Chinese or Talcott Parsons or whatever the heck you want.
    Avoiding the science is a scam. The science is hard. It is essentially a real world IQ test. If you’re not smart enough to calculate an integral or to do organic chemistry, you shouldn’t be a doctor. You will founder in the first two years of med school and you will struggle during your entire medical career. I don’t want my life in your hands.

    • http://anesthesioboist.blogspot.com T.

      As pointed out above, though, premed students who majored in the humanities or do the Mt. Sinai program HAVE to be able to calculate an integral and do organic chemistry ALSO. The perception that humanities students in medicine are “AVOIDING” the sciences is erroneous – they have to be intellectually versatile enough to apply their skills i BOTH areas.

  • Hawkeye

    If you change the yardstick from science to humanities, the same set of hypercompetitive students will ultimately just adjust to excel in this area instead. These determined students will be the most compassionate, the most empathetic, or the most whatever is necessary to get into med school.

    • jsmith

      Precisely. Smart pre-meds cannot be out-maneuvered. Best to quit trying.

  • guest

    Its possible to do both, although in the vast majority of cases I would argue that the non-science classes are substantially easier. There is a reason that engineers in general do so much better at non-science courses but the humanities majors can’t do math and science as well. I had engineering friends that took orgo with me and did above average even though they barely studied; they were competing against pre-meds that were focusing mainly on orgo. With the humanities classes we could procrastinate or churn out a late-hour essay and still get a B. If you did that with a science or math class you would most likely fail.

    This is from a non-science major, also.

  • Michael F. Mirochna, MD

    Brings up the question of the usefulness of the sciences for an actual education purpose versus weeding people out and whether if “changing the goal posts” changes the type of people who want to go into medicine or changes what the people who already are going into medicine learn…

    How do you measure how good of a doctor someone will be before they are a doctor?

    • SH

      My vote is to change the interview process to include a standardized patient session. The way a person interacts with a patient says so much more about their ability to be a future physician than their science scores or ability to sell themselves in an interview. Those things are important prerequisites (you must be able to excel or at least get through) but don’t predict your ability to communicate and advocate for your future patients.

      • Dan

        It’s pretty easy to practice for these, however. Even the most cold and nasty people can fake it for 10 minutes.

        • SH

          Perhaps, but if so aren’t they also able to outwit the current interview system with practice too? I agree that people can practice and be coached but I’m not sure you can fake through being “the most cold and nasty” for half a day. Usually schools make at least a 4-5 hour affair out of it. I’m simply proposing adding an interactive piece to the mix. I don’t disagree with the idea that students who get interviews should have rocked their science classes already. Just saying that once you’ve proved the intellectual aptitude some spark of human capacity to connect is also desired (it’s why people with perfect GPAs and scores get turned away every year). The ultimate physician would live up to Earl’s description above and be able to excel in both the science and art of medicine.

          Something like 40% of students getting into medical school these days are non-science majors. The trend is not new. But most students will still take the science courses because at least for now, you can only get into one school without them. Just food for thought. For now, I’m undecided about the program itself. I am however in full support of the idea that future physicians should be able to excel in more than just their science courses.

    • jsmith

      Calculus and physics are mainly hurdles, tests of intelligence and perseverance. Chemistry, organic chem and biology are really needed for the first two years of med school but also have some hurdle qualities as well(especially organic).
      I agree with above posters that at many colleges science and non-science courses are simply not in the same league in terms of difficulty. I took an econ class as a pre-med and was stunned to find out I had the second highest grade in a class of 250 when I simply memorized the ridiculously simple national accounting equations the night before the exam so as to plug and chug on the final. I had no knowledge of economics. Many pre-meds and physical science majors have had similar experiences.

  • Molly Ciliberti, RN

    While working for an advanced nursing degree I also had a second major in Russian Literature. We discussed often inane topics in my nursing classes (there was an obsession with writing grants) while we discussed what constitutes a good life in Russian lit. class with “One Day in the Life of Ivan Denisovich”. I learned more about patients and patient care in the later discussion than any advanced nursing class. They humanities help us to be more human.

  • minutemoon

    This is not an either/or situation. Let’s not
    forget where the word “humanities” comes
    from. The humanities represent the subjects,
    the debates, the issues that make us human.
    Before the middle of the 19th century, there
    were no “scientists” as we use the word today.
    They were philosophers — some focused on
    nature,and were thus called natural philosophers.
    Those who studied medicine were called physicians
    or doctors. But they were all PhD’s — Doctors of
    Philosophy. No one wants a doctor who doesn’t
    know the science. Doctors need to be able to
    focus on the the body, the organs, the chemistry,
    the data, the patient as object. But human beings
    are not reduced to that. The humanities help us,
    remind us, what it means to be human. Certainly
    doctors can get this on their own, outside of med
    school. Most humans engage in the humanities on
    their own regardless of their occupations. But making
    the humanities an essential part of the medical
    curriculum is important. It’s a foundational reminder
    that it’s not all about the body parts — but rather
    about how all those parts, along with somethings
    that just can’t be quantified, come together to make
    a human being. And that gives us a kind of dignity
    that one of our individual organs doesn’t have.

  • Anonymous

    What may be worth noting is that a typical humanities or social studies major program leaves a lot of free elective schedule space. So a humanities or social studies major can easily fit the “traditional pre-medical courses” (general chemistry, organic chemistry, biology, calculus, physics) into his/her studies (of course, some of these courses will fulfill breadth requirements that need to be fulfilled anyway, so the number of free electives used up is less than it may seem).

  • Cali

    Of course, I think that this is generally a good thing. Doctors should be more about helping people but it has increasingly been more about the science behind the medicine.

    I do, however, have one comment to make. The Mount Sinai Humanities and Medicine Early Acceptance Program admits students based on first year college GPA as well as the average combined SAT critical reading plus SAT math score. They are required to attend summer programs which gives them a bit of hospital experience as well as learning the pre-medical (aka hard) sciences.

    All in all, it’s not really much of a different from a humanities or social sciences student entering med school through the “traditional way”; pre-med in college on top of core modules and MCAT etc.

  • gerridoc

    You need both science types and non-science types in the medical profession. I was a Chemistry major in college, but my undergraduate advisor supported my desire to take electives in the humanities to broaden my education. I admit the first year was much more challenging for me as I was less familiar with histology, anatomy, and physiology than my peers who were Biology majors. A physician needs to have a good understanding of the human experience as well as a good scientific background. If someone chooses to major in the humanities or social sciences as an undergraduate, they should not be penalized or looked upon with disdain. The important quality is that the candidate should be capable of rigorous, disciplined study and intellectual curiosity. Lastly, physicians need to be excellent communicators, and a “purely scientific” curriculum may not always emphasize written communication skills as much as it should.