Professor Eaglen and Dean Penn offer one response to the problems of premedical education we described in our May 2008 article. Certainly, eliminating the enormous hurdle between undergraduate education and admission to medical school will reduce the relentless competition that defines the life of today’s premedical student. Freed from the need to keep their grade point averages above 3.70 and from the frightening demands of the MCAT, undergraduates can choose to explore nonscience courses and alternative learning experiences at home and abroad.
But we do not believe that baccalaureate–MD programs are a panacea for what ails the education of the next generation of physicians. We fear that these programs would displace, not eliminate, the pressure on young, would-be physicians. The shift to combined programs would simply move the competition to the high school years. High school GPA (with the requisite number of advanced placement courses) would replace college GPA, and the SAT and the ACT would replace the MCAT. Younger, less-mature students would be drawn into the competition, forced to commit to medicine before they had the chance to develop socially, emotionally, and intellectually.
Our research suggests that what premeds need most—be they college or high school students—is encouragement to reflect on their desire to become a physician. Baccalaureate–MD programs may provide some kind of structured reflection on career choice, but 15-, 16-, and 17-year-old students are not mature enough to fully explore their reasons for choosing medicine. Premeds need to think deeply about why they are seeking to become healers. This means exploring everything from their psyches to the organization of society. They must ask themselves: Do I want to become a doctor because of my deep-seated fear of illness and death? Because of the status advantages offered by the MD degree? Because other career choices are too risky or unavailable in the current economy?
Premeds also need to be able to reflect on how the experience of seeking admission to medical school is shaping their character. With limited life experience and insufficient grounding in the social sciences and humanities, high school students are ill prepared to think through the sources of their desire and the forces that influence who they are becoming. By moving younger students into the premed track, baccalaureate–MD programs make more difficult the kind of careful reflection required to become a skilled and compassionate physician.
Raymond De Vries, PhD
Professor, Bioethics Program and Department of Medical Education, University of Michigan Medical School, 300 North Ingalls Street, Rm 7C27, Ann Arbor, MI 48109; ([email protected]).
Jeffrey P. Gross
Fellow, David Shapell College of Jewish Studies, Jerusalem, Israel.