Practice II

Lewis Thomas, "How To Fix the Premedical Curriculum," The Medusa and the Snail (New York: Bantam, 1979), pp 113-15.

The influence of the modern medical school on liberal-arts education in this country over the last decade has been baleful and malign, nothing less. The admission policies of the medical schools are at the root of the trouble. If something is not done quickly to change these, all the joy of going to college will have been destroyed, not just for that growing majority of undergraduate students who draw breath only to become doctors, but for everyone else, all the students, and all the faculty as well.

The medical schools used to say they wanted applicants as broadly educated as possible, and they used to mean it. The first two years of medical school were given over entirely to the basic biomedical sciences, and almost all entering students got their first close glimpse of science in those years. Three chemistry courses, physics, and some sort of biology were all that were required from the colleges. Students were encouraged by the rhetoric of medical school catalogues to major in such nonscience disciplines as history, English, philosophy. Not many did so; almost all premedical students in recent generations have had their majors in chemistry or biology. But anyway, they were authorized to spread around in other fields if they wished.

There is still some talk in medical deans' offices about the need for general culture, but nobody really means it, and certainly the premedical students don't believe it. They concentrate on science.

They concentrate on science with a fury, and they live for grades. If there are courses in the humanities that can be taken without risk to class standing, they will line up for these, but they will not get into anything tough except science. The so-called social sciences have become extremely popular as stand-ins for traditional learning.

The atmosphere of the liberal-arts college is being poisoned by premedical students. It is not the fault of the students, who do not start out as a necessarily bad lot. They behave as they do in the firm belief that if they behave any otherwise they won't get into medical school.

I have a suggestion, requiring for its implementation the following announcement from the deans of all the medical schools: henceforth, any applicant who is self-labeled as a "premed," distinguishable by his course selection from his classmates will have his dossier placed in the third stack of three. Membership in a "premedical society" will, by itself, be grounds for rejection. Any college possessing something called a "premedical curriculum," or maintaining offices for people called "premedical advisers," will be excluded from recognition by the medical schools.

Now as to grades and class standing. There is obviously no way of ignoring these as criteria for acceptance, but it is the grades in general that should be weighed. And, since so much of the medical-school curriculum is, or ought to be, narrowly concerned with biomedical science, more attention should be paid to the success of students in other, nonscience disciplines before they are admitted, in order to assure the scope of intellect needed for a physician's work.

You could do this if there were some central, core discipline, universal within the curricula of all the colleges, which could be used for evaluating the free range of a student's mind, his tenacity and resolve, his innate capacity for the understanding of human beings, and his affection for the human condition. For this purpose, I propose that classical Greek be restored as the centerpiece of undergraduate education. The loss of Homeric and Attic Greek from American college life was one of this century's disasters. Putting it back where it once was would quickly make up for the dispiriting impact which generations of spotty Greek in translations have inflicted on modern thought. The capacity to read Homer's language closely enough to sense that terrifying poetry in some of the lines could serve as a shrewd test for the qualities of mind and chatacter needed in a physician.

If everyone had to master Greek, the college students aspiring to medical school would be placed on the same footing as everyone else. Morever, the currently depressing drift on some campuses toward special courses for prelaw students, and even prebusiness students, might be inhibited before more damage is done.

English, history, the literature of at least two foreign languages, and philosophy should come near the top of the list, just below Classics (Latin should be put back as well), as basic requirements, and applicants for medical school should be told that their grades in these courses will count more than anything else.

The first and most obvious beneficiaries of this new policy would be the college students themselves. There would no longer be, anywhere where they could be recongized as a coherent group, the "premeds," that most detestable of all cliques. Next to benefit would be the college faculties, once again in possession of the destiny of their own curriculum, for better or worse. But perhaps benefiting most of all, are the basic science faculties of the medical schools, who would once again be facing classrooms of students who are ready to be startled and excited by a totally new and unfamiliar body of knowledge, eager to learn at last, still not preoccupied by notions of relevance -- and money -- that are paralyzing the minds of today's first year medical students.

Society would be the ultimate beneficiary. We could look forward to a generation of doctors who have learned as much as anyone can learn in our colleges and universities about how human beings have always lived out their lives. Over the bedrock of knowledge about our civilization, the medical schools could then construct as solid a structure of medical science as can be built, but the bedrock would always be there, holding everything else upright.

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Page Last Updated: 8 April 2000.