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Questioning the Premedical Paradigm

Enhancing Diversity in the Medical Profession a Century after the Flexner Report

Donald A. Barr, M.D., Ph.D.

Publication Year: 2010

This book raises fundamental questions about the propriety of continuing to use a premedical curriculum developed more than a century ago to select students for training as future physicians for the twenty-first century. In it, Dr. Donald A. Barr examines the historical origins, evolution, and current state of premedical education in the United States. One hundred years ago, Abraham Flexner's report on Medical Education in the United States and Canada helped establish the modern paradigm of premedical and medical education. Barr’s research finds the system of premedical education that evolved to be a poor predictor of subsequent clinical competency and professional excellence, while simultaneously discouraging many students from underrepresented minority groups or economically disadvantaged backgrounds from pursuing a career as a physician. Analyzing more than fifty years of research, Barr shows that many of the best prospects are not being admitted to medical schools, with long-term adverse consequences for the U.S. medical profession. The root of the problem, Barr argues, is the premedical curriculum—which overemphasizes biology, chemistry, and physics by teaching them as separate, discrete subjects. In proposing a fundamental restructuring of premedical education, Barr makes the case for parallel tracks of undergraduate science education: one that would largely retain the current system; and a second that would integrate the life sciences in a problem-based, collaborative learning pedagogy. Barr argues that the new, integrated curriculum will encourage greater educational and social diversity among premedical candidates without weakening the quality of the education. He includes an evaluative research framework to judge the outcome of such a restructured system. This historical and cultural analysis of premedical education in the United States is the crucial first step in questioning the appropriateness of continuing a hundred-year-old, empirically dubious pedagogical model for the twenty-first century.

Published by: The Johns Hopkins University Press

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pp. ix-xii

This book has grown from my experiences advising undergraduates at Stanford University over a period of fifteen years. In that time I have seen many fine, fully qualified students enter Stanford with the aspiration of becoming physicians and leave Stanford to enroll in medical school as the fulfillment of that aspiration. ...

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pp. 1-10

I first began advising undergraduate students at Stanford in the fall of 1994. Early in my teaching career, one of the first of these students came to my office to ask me to be her faculty adviser. As one of the most popular majors at Stanford, the Human Biology program asks students to submit a written proposal describing the classes they will take and then to present that proposal to the faculty member they would...

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1. Who Drops Out of Premed, and Why?

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pp. 11-34

In the introduction I described my experiences advising undergraduate students in the Human Biology program of Stanford University. For many of these students,something happens early in their undergraduate experience that causes them to turn away from medicine as a career. From repeated anecdotes, I have learned that a student’s early experience in chemistry courses is often a factor in that decision. ...

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2. The Historical Origins of Premedical Education in the United States, 1873–1905

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pp. 35-54

In order to trace the origins of premedical education in this country, I have reviewed the history of the premedical requirements established by Columbia University College of Physicians and Surgeons (originally known as King’s College, founded in1767); Harvard Medical School (founded in 1783); University of Michigan Medical School (founded in 1850); Johns Hopkins School of Medicine (founded in 1893);...

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3. A National Standard for Premedical Education

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pp. 55-81

Between 1893, with the opening of the Johns Hopkins Medical School, and 1905,with the actions of the inaugural conference of the Council on Medical Education (CME), there was a remarkable coalescing of interests in the United States around a single national standard for both medical education and premedical education. ...

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4. Premedical Education and the Prediction of Professional Performance

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pp. 82-107

By 1920 premedical education had become largely standardized in the United States. Medical schools differed somewhat on the expected length of the premedical education—some expected only two years of college, while some required a bachelor’s degree. ...

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5. Noncognitive Factors That Predict Professional Performance

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pp. 108-134

In the previous chapter I traced the origins of the current system of evaluating applicants to medical school based largely on their cognitive abilities, measured as success in the undergraduate premedical sciences. However, beginning more than eighty years ago, medical educators such as those cited above were voicing concerns...

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6. Efforts to Increase the Diversity of the Medical Profession

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pp. 135-156

The 1950 graduating class of U.S. medical schools included 55 black students, 8 Latino students, and 1 Native American student, representing about 1 percent of graduates nationally.1 By 1968, the number of graduates from these underrepresented minority groups had risen to 3.6 percent of all medical students. However, more than half of these URM graduates were enrolled at either Howard University...

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7. Nontraditional Programs of Medical Education and Their Success in Training Qualified Physicians

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pp. 157-171

Since approximately 1925, the vast majority of medical schools in the United States have relied on a single paradigm for the selection of new students from among those submitting applications. Candidates were evaluated primarily based on their academic achievement in the standardized premedical curriculum of chemistry, biology, and physics. ...

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8. Reassessing the Premedical Paradigm

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pp. 172-184

I began this book by describing the experiences of students I have taught at Stanford over the past 15 years. Early in that teaching experience I recognized a pattern. Students often came to my office to discuss their academic and career plans. As part of these discussions, a number of students would describe how their interest in a career as a physician, an interest they brought with them when they first entered Stan-...

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9. Another Way to Structure Premedical Education

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pp. 185-198

I closed the previous chapter by describing the challenge issued to undergraduate colleges and universities by Jules Dienstag of Harvard. Dienstag indicated that the changes he proposed grew at least partially out of his work with a major national commission convened jointly by the AAMC and the Howard Hughes Medical Institute (HHMI) with the goal of undertaking “a joint, comprehensive assessment of...


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pp. 199-219


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pp. 221-226

E-ISBN-13: 9780801898402
E-ISBN-10: 0801898404
Print-ISBN-13: 9780801894169
Print-ISBN-10: 0801894166

Page Count: 240
Illustrations: 8 line drawings
Publication Year: 2010