Ezekiel Emanuel, the University of Pennsylvania physician and ethicist, has written an opinion piece suggesting many changes in both pre-medical education and the medical school curriculum.

He would do away with many of our hallowed medical school prerequisites such as calculus, physics, and organic chemistry, feeling that those subjects are simply used to “weed out” certain students. I confess I once believed that such subjects were worthwhile. However, Emanuel makes a convincing argument that rigorous college courses in more relevant disciplines such as statistics, genetics, ethics, and psychology with a special focus on human behavior would suffice.

Regarding medical school, Emanuel points out he was taught the Krebs cycle on four different occasions in college and medical school and never used it once in practice or research. I have made a similar observation in the past.

He considers pathology, cytology, and pharmacology to be largely irrelevant to medical practice but concedes that some may disagree.

As an ethicist, he feels that bioethics should be taught beyond physician and patient interactions to encompass areas such as “scarce resources, public health emergencies, and basic and clinical research.”

A recommendation I strongly support is that statistics should be taught again in medical school. Unless things have changed since I was actively involved with medical students and residents, even those who claimed that they had taken a statistics course had no idea what tests to use for different types of data or how to analyze a research paper.

Emanuel correctly identifies health care expenditures as another area that medical students simply have no knowledge of. In my opinion, most med students and residents don’t know the difference between Medicare and Medicaid or costs vs. charges, nor do they care.

Making these changes will not be easy. Medical schools would have to agree to revise their admission requirements, and colleges would have shift priorities to provide the necessary courses. The Medical College Admissions Test would also need to be revised to incorporate the new and eliminate the outdated material.

Everyone may not be sold on all of these proposals, but clearly something needs to be done.

By the way, Emanuel’s commentary was published in JAMA 10 years ago.

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.  

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