New York Times
POSTED: 1:30 a.m. HST, Jul 30, 2010
For generations of pre-med students, three things have been as certain as death and taxes: organic chemistry, physics and the Medical College Admission Test, known by its dread-inducing acronym, MCAT.
So it came as a shock to Elizabeth Adler when she discovered, through a singer in her favorite a cappella group at Brown University, that one of the nation's top medical schools admits a small number of students every year who have skipped all three requirements.
Until then, despite being the daughter of a physician, she said, "I was kind of thinking medical school was not the right track for me."
Adler became one of the lucky few in one of the best-kept secrets in the cutthroat world of medical school admissions, the Humanities and Medicine Program at the Mount Sinai medical school in New York City.
The program promises slots to about 35 undergraduates a year if they study humanities or social sciences instead of the traditional pre-medical school curriculum and maintain a 3.5 grade-point average.
For decades, the medical profession has debated whether pre-med courses and admission tests produce doctors who know their alkyl halides but lack the sense of mission and interpersonal skills to become well-rounded, caring, inquisitive healers.
That debate is being rekindled by a study published Thursday in Academic Medicine, the journal of the Association of American Medical Colleges. Conducted by the Mount Sinai program's founder, Dr. Nathan Kase, and the medical school's dean for medical education, Dr. Robert Muller, the peer-reviewed study compared outcomes for 85 students in the Humanities and Medicine Program with those of 606 traditionally prepared classmates from the graduating classes of 2004 through 2009, and found that their academic performance in medical school was equivalent.
"There's no question," Kase said. "The default pathway is: Well, how did they do on the MCAT? How did they do on organic chemistry? What was their grade-point average?
"That excludes a lot of kids," said Kase, who founded the Mount Sinai program in 1987 when he was dean of the medical school and who is now dean emeritus and a professor of obstetrics and gynecology. "But it also diminishes; it makes science into an obstacle rather than something that is an insight into the biology of human disease."
Whether the study's findings will inspire other medical schools to change admissions requirements remains to be seen.
Because MCAT scores are used by U.S. News and World Report and others to rank schools, the most competitive ones fear dropping the test, admissions officials said. And at least two recent studies found that MCAT scores were better than grade-point averages at predicting performance in medical school and on the series of licensing exams that medical students and doctors must take.
"You have to have the proper amount of moral courage to say, 'OK, we're going to skip over a lot of the huge barriers to a lot of our students,'" said Dr. David Battinelli, senior associate dean for education at Hofstra University School of Medicine.
But, Battinelli added, "Now let's see how they're doing five and 10 years down the road."
The Mount Sinai study did not answer the question.
There are a few other schools in the United States and Canada that admit students without MCAT scores, but Mount Sinai appears to have gone furthest in eschewing traditional science preparation, said Dr. Dan Hunt, co-secretary of the Liaison Committee on Medical Education, the medical school accrediting agency.
The students apply in their sophomore or junior years in college and agree to major in humanities or social science, rather than the hard sciences. If they are admitted, they are required to take only basic biology and chemistry, at a level many students accomplish through Advanced Placement courses in high school.
They forgo organic chemistry, physics and calculus—although they get abbreviated organic chemistry and physics courses during a summer boot camp run by Mount Sinai. They are exempt from the MCAT. Instead, they are admitted into the program based on high school SAT scores, two personal essays, high school and early college grades and interviews.
The study found that, by some measures, the humanities students made more sensitive doctors: They were more than twice as likely to train as psychiatrists (14 percent compared with 5.6 percent of their classmates) and somewhat more likely—although less so than Kase had expected—to go into primary care fields, like pediatrics and obstetrics and gynecology (49 percent compared with 39 percent). Conversely, they avoid some fields, like surgical subspecialties and anesthesiology.
But what surprised the authors the most, they said, was that humanities students were significantly more likely than their peers to devote a year to scholarly research (28 percent compared with 14 percent). They scored lower on Step 1 of the Medical Licensing Examination, taken after the second year of medical school, which generally correlates with scientific knowledge. But overall, they ranked about the same in honors grades and in the percentage in the top quarter of the class.
Humanities students were also more likely to take a leave of absence for personal reasons, which could reflect some ambivalence about their choices, the study authors said.
Typically, 5 percent to 10 percent of the class drops out before getting to medical school. Those students cannot handle the science or they have changed their minds about their intention to be a doctor, said Miki Rifkin, the program director. One who dropped out was Jonathan Safran Foer, who became an acclaimed novelist.
Kase founded the Mount Sinai program shortly after a national report on physician preparation questioned the single-minded focus on hard science.
He began with a few students from five colleges and universities that did not have their own medical schools --Amherst, Brandeis, Princeton, Wesleyan and Williams—because, he said, "we did not want to poach."
It has been going full tilt for the past 10 years and received nearly 300 applications last year from more than 80 colleges, although admissions heavily favor elite schools.
Among undergraduates accepted in 2009, the mean SAT math and verbal score was 1,444, and the mean freshman GPA was 3.74. About a third of the class had at least one parent who was a physician; among all medical schools, about 1 in 5 has a parent who is a doctor.
Among the current crop is Adler, 21, a senior at Brown studying global political economy and majoring in development studies.
Adler said she was inspired by her freshman study abroad in Africa.
"I didn't want to waste a class on physics, or waste a class on orgo," she said. "The social determinants of health are so much more pervasive than the immediate biology of it."
She added that her parents, however, were "thrilled when I decided to go the M.D. route, because they were worried about my job security."
A classmate in the program, Kathryn Friedman, 21, graduated from the Chapin School in New York City, before going to Williams, where she is a senior, majoring in political science. Her mother and uncle are doctors at Mount Sinai; her father, Robert Friedman, who works in the entertainment business, is on the Mount Sinai Medical Center board.
The humanities program has allowed her to pursue other interests, like playing varsity tennis and going abroad, she said. When her pre-med classmates hear about the program, she said, "a lot of them are jealous."
She added, "They are, like, 'Wow, I wish I had known about that.'"