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Pre-med sciences are poor predictors of performance as a physician

September 8, 2010

A recent article in The Lancet by Dr. Donald Barr lays out the available research on the utility of pre-med science courses as indicators of future performance in medical training and beyond.  Research unequivocally shows that students who do well in their undergraduate pre-med science courses (chemistry, biology, organic chemistry, and physics) do very well in their first and second years of medical school.  However, performance beyond those initial pre-clinical years is less clear.  Dr. Barr cites some research from Harrison Gough, a psychologist at the University of California, Berkeley:

Gough reported that students’ undergraduate science grades and MCAT science scores were associated with grades in the first 2 years of medical school, but were, “almost completely unrelated to performance in the fourth year and to faculty rating of general and clinical competence”. He then compared the psychological profiles of these students with their performance in premedical sciences. He found that the students who did better in science were, “narrower in interests, less adaptable, less articulate, and less comfortable in interpersonal relationships”.

The most salient consequence of relying on undergraduate science GPA* as a major component of the admissions criteria for entry into medical school is the elimination of many candidates who underperform in these sciences.  Although these candidates may not have done as well as their peers in these selected science courses, they still have significant command of this material and may possess more of the qualities–communication, compassion, empathy, and judgment–we seek in our own physicians.

As Dr. Barr concedes, science is–and should remain–the foundation of medical education.  However, competency in the sciences only forms a baseline:

There is a critically important threshold of scientific knowledge that forms the foundation on which a medical education is built. However, once one has exceeded this cognitive threshold, additional scientific knowledge adds little to subsequent performance as a physician.

The pre-medical curriculum exists to form a foundation for education in the medical sciences.  It is not designed nor expected to endow medical students with all of the science knowledge they will need.  The pre-clinical years in medical school exist for this purpose.  Therefore, admissions committees should adjust their criteria to accommodate students with average performance in the sciences but exceptional academic achievement in other areas as well as a demonstrated dedication to serving others.  Incorporating such criteria into admissions decisions is not easy.  Science GPA is a single number which can be objectively compared among students.  Assessing academic performance in disparate fields and trying to quantify each candidate’s “non-cognitive characteristics” is more troublesome.  However, we can’t afford to limit the pool of candidates to those with exceptional science aptitude.  Undoubtedly, our next generation of physicians must have the cognitive ability to deal with the increasingly rapid translation of basic science to clinical medicine.  But more importantly, they must have the ability to deal with patients who increasingly expect a person at their bedside, not a bench researcher.  Admissions decisions must evolve to ensure the best people able to fulfill both roles enter medical school.

*Undergraduate science GPA refers to one’s GPA calculated by only using grades in the physical sciences (i.e.–generally anything offered from chemistry, biology, or physics departments) and mathematics.

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2 Comments leave one →
  1. September 8, 2010 3:20 am

    I think I will print off the article and your blog posting and carry it with me to my interviews. Boom.

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  1. The value of pre-med science courses — db's Medical Rants

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