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SOME REMARKS ON THE ROLE OF CHEMISTRY IN THE PREMEDICAL CURRICULUM ALEXANDER GERO Hahnemann Medical College, Philadelphia, Pennsylvania
Umm the above title, the author presented a paper a t a recent A. C. S. meeting.' Its brief report2 elicited considerable response; a surprisingly large number of chemistry teachers in colleges wrote t o the author, either praising or damning his position. Such unexpected response convinced the author that the concern for a good pre-medical curriculum is widespread and prompted him t o investigate this matter more thoroughly and comprehensively than in the somewhat haphazard collection of views from medical school professors on which his Minneapolis talk was based. To this end. a auestionnaire (see below) was prepared and sent to the hiads of the biochemistry departments in all 81 medical schools accredited by the ~ i e r i c a nMedical Association. I n the belief that chemistry in the curriculum cannot he divorced from other subjects, the first two questions were phrased so as to state the inquiry into the premedical curriculum in quite general terms. However, the primary interest of this study is chemistry; there' Presented before the Division of Chemical Education at the 128th Meeting of the American Chemical Society, Minneapolis, September, 1955. Chern. Enq. News, 33, 4039 (1955).
fore, most questions deal with its teaching. Also, the questionnaire was sent to professors of biochemistry in the expectation that they would be the most competent t o judge how well their students had been prepared in chemistry by the colleges. This is a good place to state that the author himself did not participate in answering his own questionnaire. He is not a member of the biochemistry department a t the school where he teaches and he had no influence on any of the replies that mere given. His role is simply that of a reporter. The response from the medical schools was most gratifying inasmuch as 56 of the 81 schools sent replies, and the author wishes to take advantage of this opportunity t o express his thanks to them. Four schools preferred to state their views in extensive letters rather than by answering the questionnaire, and another 34 went to the trouble of adding remarks of some length to the completed questionnaire. These are included in the summary of replies to the extent that clear-cut answers to specific questions could be found in them. Not all who answered the questionnaire answered every question; this explains why there are, for instance, only 32 replies to question 6.
Questionnai~e (1) Do you consider applicants for admission to your medical school in general adequately prepared in their undergraduate work? no -. Yes -,
(2) If your anewer to (1) is "No," do you consider their preparation @adequate in biology -, physics -, matics -, English -, cultural subjects -, or other subjects -? (Check one or more.)
chemistry -,
mathe-
qualitative analysir (3) If your answer ta (2) is "Chemistry," do you find inadequacy in their preparation in general chemistry -, , quantitative a n a l y s i s , organic chemistry -, physical chemistry-, hiochernistry -? (Check one or more.) (4) If your answer to (1) is "No," would you advocate improving this situation by longer hours in college, some s u b j e c t s , or other means -?
greater emphasis on
(5) If your answer to (4) is "Gre&etter emphasis on some subjects," which of the following would you recommend? (Check one or more.) physics -, chemistry -, mathematics -, English -, other Greater emphasis on b~alogy-, At the expense of biology -, physics-, chemistry -, mathematics, English -, other -.
-.
(6) If you desire greater emphasis on chemistry, would you advocate greater emphasis on some fields of chemistry at the expense of others? Yes -, no -.
(7) If your answer ta (6) is "Yes," which of the following would you recommend? (Check one or more.)
organic chemi~try -, qualitative analysis -, quantitative analGreater emphasis on general chemistry -, ysis -, physical chemistry -, biochemistry -. At the expense of general chemistry -, organic c h e m i s t r y , qualitative analysis -, quantitative analysis -, physical hiochemistry , chemistry -,
-.
(8) From your experience, would you expect that the changes advocated by you in the college curriculum will improve the performance of medical students in anatomy -, histology A, biological chemistry -, physiology -, microbiology -, path(Check one or more.) ology -, p h a r m a c o l o g y , clinical subjects -?
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It should be noted that of the 12 schools which answered the first question in the affirmative only two did so unreservedly; the others hedged their "yes" about with more or less substantial qualifications, mostly to the effect that while "in general" their students were well prepared in college a certain percentage was not. One response specified the percentage as 25. Thus it would seem that the answer t o the first question hinged largely on the semantics of the term "in general." But even though some respondents were lenient enough t o answer "yes" when fully one-quarter of their students were substandard, the fact emerges clearly that 54 out of 56 American medical schools are to varying extents dissatisfied with the student material the colleges hand over t o them. One would expect this dissatisfaction t o manifest itself here particularly in the fields of biology and chemistry, the twin bases of biochemistry, since in answering the present questionnaire the medical schools are speaking with the tongues of their biochemistry professors. As expected, 38 of them registered their dissatisfaction with the applicants' training in chemistry and not many fewer with mathematics and English, but i t is somewhat surprising that not one was dissatisfied with biology training. Whether this is due to superior performance of college biology departments compared t o that of chemistry departments, or to the opinion that for future physicians biology is less important than chemistry, can be decided readily by examining the numerical distribution of answers t o questions (4) and (5). By far most of those who considered the suggested remedies for the inadequate preparation of college graduates recommended a shift in emphasis on college subjects. The most frequent recommendation (as one would expect from the answers t o question (2)) is extra emphasis on chemistry, mathematics, and English. It is significant that not only no desire was expressed for added emphasis on
biology but also almost half of those who answered the second part of question (5)recomrnended that the change in emphasis should be made a t the expense of biology. Apparently medical schools do not look upon undergraduate biology as very important. One school voiced the opinion of many that "biology departments (and the pre-medical advisors who stem from these departments) exert far too much power in advising pre-medical students to major in biology rather than in chemistry. . . .?re-medical students frequently choose the way of least resistance by selecting biology rather than the more exact science courses." Many of those who made additional remarks on the questionnaire went into considerable detail regarding the widespread deficiency in English and mathematics. It was a universal complaint that college graduates are very inadequate in their ability to express themselves clearly and concisely, and even to spell correctly; likewise, too many are unable t o handle simple mathematical methods. Both these deficiencies, it was said, indicate a lack of precision of thought which is a serious defect in anyone engaged in the study of medicine. ("No wonder," wrote one respondent, "that they can't rearrange the equation PV = nRT!") Also interesting is the fact that while less than 10 per cent of all respondents desire added emphasis on physics, nobody is willing to sacrifice any of the present emphasis on this science. Regarding the detailed criticism of undergaduate chemistry, questions (3), (6), and (7) should be considered together. Manifestly, physical chemistry, organic chemistry, and quantitative analysis, in this order, are the major areas of dissatisfaction. Those who desire a change of emphasis within the chemistry curriculum outnumber those who do not by more than two to one, and, of course, added emphasis is recommended for the same subjects in which the students entering medical school are found wanting. Here, too, negative
Summary of Answers to the Questionnaire
(1) Applicants to medical school are generally: adequately prepared (121,' inadequately prepared (44). (2) Inadequacy psrticulssly in: biology (O), physics (12), chemistry (38), mathematics (30), English (29), cultural subjects (5), other (3). (3) Inadequacy in chemistry particularly in: general chemistry (41, qualitative analysi. (51, quantitative analysis (18), organic chemistry (24), physical chemistry (25), biochemistry (0). (4)
Inadequate preparation should be remedied by: longer hours in college (2), greater emphasis an some subjects (30), other means (12).
(5) There should be greater emphasis on: biology (O), physics (5), chemistry (a), mathematics (22), English (21), other subjects (3). at the expense of: biology (13), physics (O), chemistry (O), mathematics (O), English (0), other subjects (15).
(6) Greater emphasis on some fields of chemistry at the expense of others is: desirable (23),
undesirable (9).
(7) Among chemical subjects, there should be greater emphasis on: general chemistry (31, qualitative analysis (2), quantitative analysis (15), organic chemistry (13), physical chemistry (14), biochemistry (0). a t the expense of: general chemistry (4),, qualitative analysis (7), quantitative analysis (I), organic chemistry (0), physical chemistry (2), blochemistry (18). (8) The changes advocated should improve medical students' performance in: matomy (I), histology (3), biochemistry (38), physiology (30), microbiology (14), pathology (6), pharmacology (26), clinioal subjects (13). a The numbers represent the number of respondents checking each specific question.
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results are relevant. Although organic chemistry is slightly behind physical chemistry and quantitative analysis in the demand for added emphasis, nobody is ready to give up any of the present emphasis on it. This is not true of either physical chemistry or quantitative analysis. It appears that in the view of the medical schools physics and organic chemistry occupy particularly essential positions in the pre-medical curriculum. On the other hand, not only does nobody desire added emphasis on biochemistry, but also more than half of those who answered the second part of question (7) consider undergraduate biochemistry expendable for the benefit of other subjects. In fact, it was repeatedly noted on the questionnaires that biochemistry should not he a pre-medical subject at all because i t cannot be properly understood without sufficient grounding in physical and organic chemistry and in quantitative methods; and since so many pre-medical students are deficient in these subjects, they are wasting their time studying biochemistry and acquiring little more than the illusion that they have learned something. It was suggested that they would profit more by improving their knowledge of organic and physical chemistry than by entering, insufficiently prepared, on the study of biochemistry which they will take in medical school anyhow. Beyond the answers to the questionnaire discussed in the foregoing, many of the respondents raised interesting points not anticipated by the author when he made up his questionnaire. Foremost among these, both in frequency and in urgency, was the opinion that improvement in the quality of college teaching is more needed than quantitative change in either total hours or hours devoted to particular subjects. The colleges were criticized for emphasizing a profusion of factual detail rather than aiming a t thorough understanding of fundamental principles, for neglecting to insist on quantitative aspects of science from the freshman year on, for training students too much to memorize and not enough to reason, and last, hut not least, for failing to inculcate proper motivation. As a result, students generally choose the easiest way out and realize too late the importance of disciplined thinking, scientific reasoning, and handling mathematical concepts. It was pointed out, however, that in fairness this state of things should not be blamed on the colleges so much as on the educational philosophy prevailing in high schools and grade schools. Specific suggestions also were made. It was often proposed that the quantitative and theoretical aspects of the sciences should be emphasized more than the qualitative and descriptive aspects. Many also wanted more effectiveteaching of first-year organic chemistry. What they mean by that may be illustrated by the observation of one respondent that most of the candidates he examines know all about the details of the petroleum industry and about fancy "name" reactions, but when asked how to identify a compound suspected to he an amine, they would never think of testing it for basicity. Thus the main attention in elementary or-
JOURNAL OF CHEMICAL EDUCATION
ganic chemistry should be directed to the behavior of functional groups. For instance, "it is not important for an undergraduate to have studied the chemistry of carbohydrates, hut it is important for him to know the chemistry of the alcoholic hydroxyl group and of the carbonyl group so well that he has no trouble understanding carbohydrate chemistry in medical school." It was also repeatedly suggested that the entire premedical chemistry curriculum be revised and a twoyear course designed which would include all fundamental information on inorganic, organic, physical, and analytical chemistry. This suggestion, however, was far from unanimous; there were those who objected to separate courses for pre-medical students for fear that such courses are likely to be poor compared to courses offered to chemistry majors. What, it may be asked, should the colleges do in this situation? It will be argued by some that a college is an integral educational institution in itself and not primarily a pre-professional school. No doubt this is true, but it is equally true that many college graduates -and particularly the best ones-go on to graduate and professional schools. The colleges owe it to these students to prepare them properly for their advanced work, and in order to achieve this aim the opinions of the professional schools should be heeded. It seems to the author that many of the recommendations made in the present survey by medical schools mill be unexceptionable to colleges. Greater emphasis on fundamentals, on correct use of the English language, on clear thinking and concise expression, and on ability to handle mathematical concepts and methods are ideals with which few will quarrel. Nor will many oppose the suggestion that students should not be eucouraged to take the path of least resistance, even if this might scare some marginal candidates away from an attempt at a college career. High standards are at least as important as high enrollments. There may be disagreement over specific suggestions and criticisms, as for example over the insistence of the medical schools that biology should not be considered as important as chemistry in the premedical curriculum, and that biochemistry should not he taught a t all in college. But on these points, i t would seem that the opinion of the medical schools should be respected, if only because about 120,000 members of the college population of the United States prepare themselves to continue their studies there. It should not he too hard to adapt the pre-medical curriculum to the demands of the medical schools. What is called for, apart from the general principles already discussed, is encouragement of the pre-medical student to devote more of his time and attention to chemistry, particularly organic and physical chemistry, to train himself in quantitative methods, and to study mathematics earnestly and generously. As to undergraduate hiochemistry, many colleges will be reluctant to abandon it. But, as the author pointed out in his Minneapolis talk, it is quite possible to teach a fourth-year college course which approaches biochemistry from the side
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of chemistry and emphasizes organic chemical and from their experience, they expect improved performphysicochemical aspects of the subject matter rather ance of students trained according to their prescription, than traditional hiochemistry. The author himself not only in biochemistry but in other quite unrelated taught such a course for years, and the students who subjects. Obviously, they consider that their recomtook it went on t o make outstanding records in medical mendations should improve the all-round training of pre-medical students. Any change which promises school. It is worth pondering that in their answers to question such improvement is worth the most serious considera(8) of the questionnaire the medical schools state that, tion.
