Early experiences in one or more chemistry courses appear to be a principal cause of the observed decline in interest in continuing premedical studies among students at both the University of California, Berkeley and Stanford University. The discouraging effects of chemistry courses appear to be felt more acutely by URM students at both campuses.
From the results of our interviews it appears that the adverse effects of chemistry courses experienced by many of the URM students lead directly to these students questioning their own ability to continue to pursue a medical career, and as a consequence dropping medicine as a possible career option.
Many of these students may have come from high schools that had relatively weak offerings in the sciences, placing these students at a disadvantage relative to students not from a URM group who may have attended a more privileged high school with stronger science preparation. In addition, a majority of these URM students at Berkeley are women and, as studies of elementary and secondary education have suggested (Seymour and Hewitt 1997
), may have experienced additional disadvantage in their early science education. For these students, entering Berkeley with the hope of becoming a physician and then having a negative experience in a chemistry course is a major turning point in their professional life. In the words of two of the students whose interview text appears above:
I didn’t think that I could do very well in the chemistry classes…I wanted to be pre-med when I first got here. But then after the first semester, I stopped.
I’m sorry, but chemistry is just… I don’t like doing that…This is just like the peak. You like it or you don’t. This is the turnaround point.
At the beginning of the twentieth century, medical education in the US became differentiated from that in the UK and parts of Europe, in that the educational sequence was split into separate phases at the undergraduate and medical school levels. Early courses in the sciences of chemistry, biology, and physics were assigned to the undergraduate curriculum. The most typical sequence of science courses in the US, adopted initially in 1905 (Bevan 1905
) and still the norm today, expects first year students to take an introductory course in chemistry, with additional courses in biology and physics in the second year or later for those students successfully completing their first-year chemistry courses. This course sequence may partially explain why students identified courses in chemistry so much more often than those in biology or physics as having a discouraging effect on continued interest in pursuing a medical career. However, even for non-URM students, most of whom successfully complete their undergraduate science courses and subsequently move on to medical school, chemistry courses were substantially more likely to have a discouraging effect than other science courses. Thus there may be some unique aspect of the curriculum or pedagogy of chemistry that discourages most students from pursuing a medical career, but does so disproportionately for URM students.
In the responses of the interview subjects, some students indicated that they felt out of place in the chemistry classroom, while others referred to the difficulty they were having in meeting the work load and academic demands of chemistry. The question arises as to whether those students who are unable to attain the level of academic performance expected in chemistry courses can reasonably expect to succeed in medical school. Studies from both the UK (McManus et al. 2005
) and the US (Mitchell 1990
) have documented a consistent association between performance in introductory courses such as chemistry and performance in the preclinical years of medical school. However, as concluded by Montague and Odds, “In general these studies have indicated that there is a positive correlation between performance in science A-level or equivalent examinations and performance in the early part of the medical course, but that this correlation decreases as students progress through the course” (Montague and Odds 1990
, p. 151).
In 1953, a report issued by the national Survey of Medical Education titled Preparation for Medical Education in the Liberal Arts Colleges
, observed that introductory science courses were often used at colleges and universities throughout the US to prevent students who do not do well in them from, “cherishing inappropriate professional ambitions too long” (Severinghaus et al. 1953
, p. 11). The report went on to note that many students were “weeded out” in this manner as the result of, “an unduly tough attitude on the part of many chemistry teachers who claim with pride that only students of good ability who work very hard can get through their chemistry course.” The authors of report, representing a number of leading medical schools, spoke critically of the role chemistry courses had assumed in this “weeding” process: “…it is surely bad educational practice for one teacher, or one department, to act as a self-appointed obstacle. Administrators should see to it that this attitude is not permitted to develop or continue” (Severinghaus et al. 1953
, p. 99).
At both private universities such as Stanford and public universities such as Berkeley, this weeding process continues and falls disproportionately on URM students, many of whom are the very students the University of California system of medical education is expected to train as physicians to meet the health manpower needs of our increasingly diverse state (Grumbach et al. 2008
). It appears that the time is right to undertake a fundamental reassessment of the historical role chemistry courses have played in the premedical curriculum at colleges and universities throughout the country.
Repeated studies in the US have shown that undergraduate performance in premedical sciences such as chemistry, while predicting performance in the preclinical phase of medical education, has little if any power to predict the subsequent clinical skills of medical students, acquired in the final years of medical school or the early years of residency training (Veloski et al. 2000
; Donnon et al. 2007
; Basco et al. 2000
; Violato and Donnon 2005
). As described by Jules Dienstag of Harvard University, “the topics covered in many courses in chemistry, physics, mathematics, and even biology are so removed from human biologic principles that they offer little value to the premedical—or advanced human biology—student” (Dienstag 2008
, p. 221).
The sequence of science courses required for admission to US medical schools, first defined in 1905 by the Council on Medical Education of the American Medical Association, has changed little since that time. One must question whether, after more than 100 years, there might be more innovative ways of organizing the teaching of premedical science. In many universities in the UK and Europe, the science preparation for medical training has been streamlined, focusing principally on those aspects of chemical knowledge truly necessary to succeed in clinical training and as a physician. Many educators in the US have suggested that premedical science training within the undergraduate university could be simplified and made more efficient in preparing students for medical school.
Dienstag goes on to argue that, “premedical requirements for rigid, 1-to-2-year, discipline-specific science courses should give way to more creative and innovative courses that span and unite disciplines…Medical schools should stimulate colleges to innovate, and premedical students should demand science courses that prepare them directly and efficiently for the advanced study of biology. Premedical science should never have become a ‘trial by fire.’” (Dienstag 2008
, p. 223).
The “trial by fire” of the first-year chemistry classroom is overdue for reform. That reform will likely involve new pedagogical approaches to the teaching of chemistry as but one of several contributors to our knowledge of human biology, rather than a course whose purpose is to “weed out” otherwise qualified students who hope to become physicians.