PREMEDICAL REQUIREMENTS IN CHEMISTRY* A data sheet for this committee was prepared by the Committee on Naming and Scope of Committees. In the investigation of the problem and in this report, this sheet has been our guide and bas been of great assistance. Except for one combination of topics and one addition, we have followed it closely. The materials used were reports of the American Medical Association, the Third Report of the Commission on Medical Education, including the Supplement, Reports of the Bureau of Education, numerous college and university catalogs, letters from the deans of practically all the approved medical colleges in the United States and Canada, letters from professors of physiological chemistry in medical colleges, the report of Roy I. Grady, presented a t the Buffalo Meeting, and the paper of Jack P. Montgomery, read a t the Indianapolis Meeting. In the following discussion there are, of necessity, frequent ovedappings, as it is difficult, from the nature of the material, to give a reliable and clearcut cross-section of opinions. The attempt has been made, however, to thoroughly analyze the report and it is hoped that, by reference to topics, the reader will be able to find readily the information desired. (1) Present Rules and Practices Regarding Minimum Subject Matter,
Including Laboratory Work The present published minimum requirements of the American Medical Association in chemistry include twelve semester hours, of which eight must be in general inorganic chemistry, including four semester hours of laboratory work; and four semester hours of organic chemistry, including two semester hours of laboratory work. Work in qualitative analysis may be counted as general inorganic chemistry. The great departure from this rule in practice is revealed in Bulletin 159 of the Committee on Medical Education of the American Medical Association. Of seventyseven approved medical schools in the United States, thirty of the fouryear and two of the two-year schools are listed a$ requiring the minimum, while the remaining thirty-five indicate further requirements. Judging by letters received from the deans or other officers, it is indicated that twenty-eight of the schools publishing only the minimum requirements really require or urge additional preparation in chemistry. In only three cases was satisfaction expressed in regard to the present minimum in chemistry. Almost without exception the Canadian schools regard the minimum as entirely inadequate. This feature of the report is emphasized particularly for the benefit'of those responsible for making up premedical curricula. It has always been difficult to plan the work of a student to accomplish the broad cultural and humanistic background, and a t the same time meet all the specific requirements. At the present time, each medical school interprets its own requirements very liberally, and frequently accepts students deficient in some of the actual published requirements which are not so fundamental; why not, then, simply publish what is already more or less of a general policy? * A committee report which was approved by the Senate and Division of Chemical Education at the New Orleans Meeting, March 30, 1932. The information contained therein formed the major portion of the paper presented at the same meeting of the A. C. S. by Jack P. Montgomery before the joint meeting of the Divisions of Chemical Education, and Biological and Medicinal Chemistry. 1117
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The medical colleges do not seem inclined to commit themselves to this extent and, to be on the safe side, those of us who are responsible for premedical courses in chemistry should be informed of their general intentions and strike as happy an average as we may. (2)
The Question of Organic Chemistry in Addition to the Required Four Semester Hours
Forty-one medical colleges appear to he quite satisfied with the present requirements in organic chemistry. Some of the deans, and other officers, of these schools have written that in the four-hour course, both aliphatic and aromatic divisions should he included. Representatives of five of these schools feel that if the course is limited to four hours, the work should he didactic in character, and that laboratory work should not be included unless i t is different from the usual organic preparations type. This will be referred to again under (6). Twenty-nine colleges require additional hours in organic chemistry, and thirty-sii desire a greater preparation. While the question remains unanswered in part, there is a clear indication that, unless the four-hour course is carefully planned to include, rather intensively, both aliphatic and aromatic divisions, additional hours are ahsolutely necessary for adequate preparation. The Question of Quantitative Analysis At the present time, only fifteen medical colleges ahsolutely require quantitative analysis, and two plainly state that they do not even desire it, hut, on the other hand, forty express a decided preference and state that it is a necessary adjunct to the study of physiological chemistry. In two cases it was suggested that a combination of organic and quantitative would be desirable, the eight-hour organic course being altered in such a way that the time usually given Fo organic preparations be devoted to volumetric analysis. In this connection, the desire that the volumetric and colorimetric aspects of quantitative he stressed was volunteered by representatives of eleven medical colleges. I t appears, therefore, that from two to four semester hours should be included in the minimum requirements. (3)
(4)
The Question of Physical Chemistry
None of the medical colleges require physical chemistry a t present, and six say that i t is entirely useless for their purposes. It seems to be the case, however, that in a number of medical colleges a part of the time a t the beginning in physiological chemistry is devoted to those phases of physical chemistry which will illuminate and make clearer the physiological chemistry course. In order to avoid this waste of time, and as a preparation for physiological chemistry, some kind of physical chemistry is desired by fifty-three medical colleges, hut there is an ever-recurring criticism of the content of the physical chemistry course as usually given. A course which is less mathematical, more explanatory, and more specifically directed toward the study of biochemistry seems to he desired. On the other hand, there are a few who would like to see a much more rigorous course.
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It appears that a special course in physical chemistry for premedical students should be included under the suggested courses, but that no physical should be required at the present time.
(5) What Approved Medical Schools Expect and Desire Their Freshman Students to Know in Chemistry
In general, a four-year medical course is divided about equally between pre-clinical and clinical instruction. Physiological chemistry is given in the pre-clinical period and, when thoroughly learned, becomes the portal to all the chemical aspects of the remainder of the course. It has become very important, therefore, for the freshman in medical school to be able to carry on well from the beginning in physiological chemistry. This means that the medical school may well expect the freshman to he sufficiently prepared in chemistry to do satisfactory work in physiological. To quote a prominent dean, "The relationship which chemistry bears to an accurate study of metabolic and other diseases and to research makes a comprehensive knowledge of the subject particularly valuable and desirable." Another dean says, "Many of the important advances made in medicine in the past twenty years, and those still in progress, are in the field of biochemistry, and much of modern medicine is, to a large extent, applied biochemistry. We, therefore, regret the increasing difficulty in teaching biochemistry because of the fact that students are inadequately prepared." Other comments along the same lines may be summarized to mean that the medical schools expect and desire their freshmen to have about the following equipment in chemistry: (1) An intellectual appreciation of chemistry as a science in its
universally useful aspects. (2) Thorough grounding in those principles which are most general in their applicability, resulting in a unfication of the entire chemistry course. (3) Adequate training in outstanding theories, not as a means of "explaining" facts, merely, but as a useful method of developing the quality of comprehension. (4) An ever-increasing ability to blend the contributions of chemistry with the contributions of other sciences in his appreciation of life processes. (5) Appreciation of the quantitative method in developing a sense of proportion and in increasing technical skill in the use of apparatus for measurement and control of conditions of measurement. (6) The realization that, although his previous training may have been quite broad, much of what he has learned is now ready to be profitably applied to and incorporated with his acquisition of physiological chemistry. (6) Recommendations of the Outlines of the Contents of Courses
In discussing the content of premedical chemistry courses, we are certainly upon safe ground if we assume that the teaching should result in a contribution to general education and educative processes quite as much as in meeting the needs of premedical training, and yet there are
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insistent demands that separate sections be organized for premedical students. It seems to be the decided opinion that the chemical training of premedical students has not been given sufficient attention. It is deplored that the custom seems to have been adopted of forcing these men through a routine set of courses primarily planned for those who intend to become chemists. Yet, running through these appeals for courses more specifically premedical, there is the insistent demand that broadness in educational outlook shall not be sacrificed. Many are of the expressed opinion that the character of instruction given is of far greater importance than the number of required hours in so many subjects. Unification of interest, sequential development, deep comprehension of principles, and the quantitative attitude are greatly to be preferred to diverse interests in following routine procedures which may cause the student to be "lost in the mazes of a spurious accuracy." General Inorganic Chemistry-Motivation certainly should not be from the standpoint of the particular interest of the teacher, the former methods of the department, or application to industry, but more as a part of general education, directed to the specific blending with medical education. The ideal should be to overcome the lack of initiative and sense of responsibility for their own education which many students reveal, and to lead them to think for themselves, to the end that they will not fail in the retention of knowledge of fundamental principles and facts, or in the utilization of what is retained when encountering new relationships and applications in later work. The course should be a t least an eight-semester-hour one, with half the credit time devoted to laboratory. Stoichiometry should be included to a sufficientextent, that the student may begin to appreciate the quantitative attitude. Some of the concepts of physical chemistry should be introduced, and their exposition maGe a part of the laboratory work. Instead of many details and facts, comprehension of general principles should be stressed. The class work should be largely in the non-metallic field. The last half of the laboratory work may well be largely in qualitative analysis, but a few quantitative exercises should be introduced. Energy relations should be included sufficiently to impress the student that chemistry is not merely the study of matter. Organic Chemistry.-If, as is frequently the case, organic chemistry is taken in the second year, motivation may well be directed along two lines, making it as far as possible a continuation of general chemistry, and, specifically, an "illumination of chemical constitution, whereby there are established genetic relationships between apparently diverse substances and the demonstration of repetition in types of union, in substituent groups, in types of reaction, and in application of theories." Some of the concepts of physical chemistry may he given new applications, and the quantitative attitude should be further developed. At the present time it seems unwise to insist upon more than a foursemester-hour course, when both aliphatic and aromatic divisions are included, but premedical courses should provide an additional four hours where possible. Certainly, when it is known that large numbers of stu; dents in the premedical course may apply to medical colleges requiring or desiring eight hours, the course should be given. As to laboratory work, the desired allotment seems to be that half the credit hours shall
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be devoted to that phase of the course. Organic preparations merely seem to be of little value unless each one illustrates a valuable principle. Rather let the laboratory part be an integral illustrative item of the didactic work. A few suggestions have been made that we may well substitute physical chemistry or quantitative analysis for organic laboratory. Quantitative Analysis.-Quantitative analysis for premedical students should be largely volumetric, and may serve the triple purpose of further unification in and appreciation of the former courses, furthsr exposure to some of the concepts of physical chemistry, and direct preparation for some of the laboratory procedures of physiological chemistry. Routine methods must not be allowed to rout comprehension, but a reasonable accuracy must be demanded. The ideal is to deliver the student to the instructor in the physiological chemistry laboratory with a knowledge not only of how, but of why and when to proceed. At least two.semester hours, but preferably four, should be included in the premedical course. Physical Chemistry-Many comments upon physical chemistry are to the effect that, as now given in most colleges, it is useless to the medical student. At the same time, there is a recurrent demand that the physical chemistry viewpoint as applied to biochemistry be given in as large measure as is possible. A few suggestions have come that an entirely different kind of physical chemistry course ought to be introduced especially for premedical students. A much wider view seems to be that i t is possible to give the premedical student all the physical chemistry needed if general inorganic, organic, and quantitative chemistry are unified from the physical chemistry standpoint. It is not recommended that physical chemistry as i t is now given be included in premedical courses. On the other hand, it is urged that attention be paid to the suggestion of unifying the entire course on the basis of the concepts of physical chemistry. (7) The Desirable Minimum Requirements Instead of the present published minimum of the A. M. A,, the following seems more desirable. General Inorganic Chemistry, eight semester hours, of which half the credit hours shall be in laboratory work, including qualitative analysis. Organic Chemistry, six semester hours, provided the work includes both aliphatic and aromatic divisions, but eight hours are to be preferred. Of the credit hours required, from one-fourth to one-half shall be in laboratory work. Quantitative Analysis, three semester hours, of which two credit hours shall be in the laboratory work. Committee on Premedical Requirements i n Chemistry, Division of Chemical Education of the A. C. S. JACK P. MONTGOMERY, Chaivman R. I. GRADY F. C. IRWIN E. E. REID
