We knew we needed more physicians well before the COVID-19 pandemic.
But now it’s clear that the need is not just for more physicians, but physicians with a public health background. It’s physicians who are well versed in statistics and probabilities; physicians who understand how society determines health. And, most importantly, we need physicians who look like Americans—all races, ethnicities, genders, and religions.
Unfortunately, premedical education is rife with problems. Money is a barrier. Medical students are still more likely to come from families with a parent as a physician compared to other sectors. And this, along with the rising cost of attendance and flatlining physician salaries, means that medical students are still likely to come from families with higher incomes.
The lack of physician diversity has continued to be a stain on the profession. In fact, over the last 40 years the percentage of African-American males in medical school has not changed. This is despite increasing efforts to promote diversity, holistic medical school application review, and a new Medical College Admissions Test (MCAT) in 2015.
In addition, the delivery of premedical education has remained largely unchanged for a century. Yet, medical schools have added more and more prerequisites (molecular biology, biochemistry, psychology, sociology, etc.) which places an increasing demand on our premedical students, leading to difficulties in completing the program or burnout for those that did.
Change won’t be easy, especially at large institutions with no incentives, but they are necessary. Pre-medical students make up the bulk of biology, chemistry, and physics students across the country. Buildings have been designed to hold these masses of students. Tenured faculty have been hired to teach them. And in many cases, graduate students (used to conduct faculty research) have their fellowships paid by teaching pre-medical students.
So, how do we change? It starts with being nimble and pivoting to meet the changing needs of the students. This is easier for liberal arts colleges that have long been leaders in student-driven experiences and pedagogical advances. These colleges are small by design, allowing them to be the driving force behind fundamentally changing how premedical education is taught and implemented.
At Albion College the Lisa and James Wilson Institute for Medicine is embarking on college-wide premedical curriculum reform.
This process began with the 2019-20 academic year and the formation of two new courses that were designed to address the widening disparity seen in incoming first-year students. Well prepared students, with a plethora of Advanced Placement and dual-enrollment credits, were placed into a novel cell and molecular biology and organic chemistry course. Students without that extensive preparation were placed in a team-taught pre-medical STEM course, which was aimed at building science literacy, data analysis and study skills.
The Wilson Medical Institute is also innovating outside the classroom, with an eye on leveling the playing field for all students interested in a career in medicine.
A dedicated staff member was hired to place students into experiential learning opportunities with alumni, including clinical, service, and research positions. In addition, a novel Graduate Admission Preparation course was developed that included free MCAT preparation via a partnership with Kaplan. These efforts are designed to ensure that all students, regardless of personal network and financial means, can build the necessary experiences and test scores to gain entry into medical school.
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And now in the midst of the COVID-19 pandemic, the Wilson Medical Institute is adding a new public health program to our premedical curriculum overhaul. This includes the development of new courses, a public health living-learning community, and public-health focused service and research opportunities. These opportunities will be available to students starting this fall.
The COVID-19 pandemic is a disrupting force in higher education but it is also an opportunity for colleges to adapt their programming. This is especially needed in premedical education where curriculum reform is overdue.
Premedical education is going to change. It has to. And small liberal arts colleges have the ideal opportunity to lead the way.
Bradley Rabquer is director of the Wilson Institute of Medicine and associate professor of biology at Albion College in Michigan.