Why premedical education is disconnected from medicine

Premedical education has become disconnected from medicine. Rather than helping students evaluate whether medicine is right for them or preparing students to enter the discipline, the premedical gauntlet encourages students to blindly discipline themselves according to rigid criteria.

For example, during a recent trip to the pre-health advising office at my university, my advisors presented me with the “A.C.E. checklist.” It includes the three accomplishments every candidate should have before applying to medical school: academic success, clinical exploration, and life experience.

I don’t have a problem with the idea of a pre-med checklist.  After all, it’s three part imperative makes sense.  No one benefits if a student enters medical school academically ill-prepared, unfamiliar with clinical realities or without having explored the world outside medicine.

My problem is that pre-medical students, myself included, often feel so intimidated by the rigor and mystique of the medical school admissions process that we don’t take time to question the limitations of checklists like these. Consequently, the checklist’s common sense tenets get distorted by the strain and demands of the premedical education.  Its helpful suggestions calcify into rigid maxims.

Unsurprisingly, premedical education then becomes a formula to be optimized, rather than an experience to be lived.  It becomes a game where the key to success is, above all else, following someone else’s rules.

Academic success becomes a game when courses are interpreted as grade points to be accumulated, rather than opportunities for learning and enrichment. I’ve spent too many hours scouring through the website, Rate My Professors, selecting professors only based on their grading habits.  I’ve heard too many whispers of self-flagellation fill lecture halls after graded chemistry exams are passed out: “I hate myself,” “Why did I try,” or, “I’m a stupid failure.”  I’ve witnessed some of the brightest and kindest students at my university be driven to frenzied panic after receiving a below average score on an exam.

A hypercompetitive, prestige-burdened medical school admissions process has created an inverted incentive system: Grades, rather than knowledge, become the prize to be won.

Clinical exploration becomes a game when clinical opportunities are transformed into commodities to be won. In a previous post I wrote, I described an extreme example: One pre-med club at my university offers “points” for members who volunteer to carpool or set up club events. These points can be exchanged later to accumulate valuable clinical experiences, such as shadowing physicians who have partnered with the organization.

It’s not always this bad, and there are still many opportunities for genuinely curious students to explore medicine. But the invocation to get clinical experience in order to apply for medical school still feels backwards. Since when did it make sense first to decide to become a doctor and then to get experiences to learn about medicine? Many premedical students feel pressured to make a conclusion before seeing the evidence.

Life experience gets its own category in this checklist, but it felt strange that someone felt it was necessary to remind me that things outside the clinic or classroom still have value. Perhaps that’s because I often feel pressured to answer the question, “Why did you decide to become a doctor?” with an airtight, neat narrative not at all representative of my winding path to medicine.

The good news is that such deficiencies are not a reflection of medicine itself. Rather, they are a result of the competitive, pressure-filled medical school application process that often starts the day students step on campus and take their first introduction to chemistry class.

The deficiencies in the medical school application process are systemic and entrenched. But my peers are finding solutions by taking time to pause, reflect and interrogate the demands the premedical gauntlet places on them.

These are the students who don’t see biology as a default major, especially if they are studying biology. These are the students who interrogate medicine’s assumptions and creeds, the students who feel unsettled after an evening in the free clinic, who ask the next morning, “What did I really just see? Does it have to be that way?”

They are the students who believe life happens every day, not when the first medical school acceptance letter arrives in the mail. They are the students who attend outside seminars, student protests or rock concerts even if they occur the night before an exam — because genetics will be there the next day, but the strokes leave town tomorrow.

They include my friend who, despite being at the end of her shift in the ER, doesn’t stop herself from crying after witnessing a penniless man with alcoholism drink hand sanitizer. Or my classmate who rolled his eyes, pat himself on the back and bought a tub of ice cream after receiving a “B-” in organic chemistry. Or my friend who writes corny poetry in coffee shops on Sunday afternoons, not to improve her life experience, but because she can.

In short, they are the kind of people I would want my physician to be.

Christopher Cai is an undergraduate student.

Image credit: Shutterstock.com

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