More About Premedical Education

Sandroni, Stephen MD

Academic Medicine:
doi: 10.1097/ACM.0b013e3181a43b77
Letters to the Editor
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Director, Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania; (

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To the Editor:

In your May 2008 editorial,1 you explained why the vast variety and potentially enriching course offerings of the undergraduate world are currently avoided by most premed students. Actions taken by the students and their advisors will be—as they are now—influenced by the perception of what is most useful to achieve admission to medical school. The medical schools, therefore, hold the cards in terms of changing the scope and quality of students’ undergraduate experiences, and efforts to make those changes must focus squarely on the admission process.

Realistically, broad implementation of a multipronged strategy would require a degree of consensus unlikely to form in the current fragmented culture of medicine. For that reason, deliberately supporting a radically different approach by a small cadre of committed medical schools might offer an expeditious way to experiment with one or more alternate schemes for the admission process. Key elements of alternate schemes would ideally be left up to each participating school in the cadre, to encourage innovation. Ideally, there would be freedom to eliminate any or all current requirements and to substitute others. (Perhaps we should revisit Isidore’s recommendation to included rhetoric in the premedical curriculum.2) There should also be latitude with regard to use of alternate admission tests, if deemed appropriate.

History and science remind us that there are multiple paths for the cultivation of creative and independent thinkers. Promoting rapid innovation in multiple settings as suggested above might result in more options, with more opportunity for reassessment, than would struggling over a longer time to reach a broad but untested consensus.

Stephen Sandroni, MD

Director, Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania; (

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1 Kanter SL. Toward a sound philosophy of premedical education. Acad Med. 2008;83:423-424.
2 Sharpe WD. Isidore of Seville: The medical writings. An English translation with an introduction and commentary. Trans Am Philos Soc. 1964;54(Part 2):64.
© 2009 Association of American Medical Colleges