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How one college is helping premed students escape the `syndrome'

Pre-meds. They are college undergraduates bound for medical school. And in the lexicon of modern academia, few terms provoke such sharp response as the label by which this sector of the student population is known.

Say ``pre-med'' to a teacher, an administrator, a student, or even a pre-med and there's a decent chance you will have invoked the image of a scholastic mercenary, obsessed with the idea of gaining entrance to the medical school of his or her choice.

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Such stereotypes are unfair, of course. But a recent assessment of medical education by the American Association of Medical Colleges did finger the extreme competition for entry into American graduate schools of medicine as the cause of a ``premedical syndrome'' among some. For those students, the report observed, ``college is not a place to sharpen critical skills, investigate options, and experience intellectual stimulation and growth. It is a mine field to keep them from their goal of entering medical school.''

At least one university has taken a bold step to change that scenario, however. In what it has called the most ambitious integration of liberal arts and medical education to date, Brown University is embarking on plans to merge its college and medical school programs. From here on, virtually all of Brown's medical students will be admitted directly from high school.

The new eight-year course of study will get underway next fall. Officials at Brown say this Program in Liberal Medical Education (PLME) aims to accomplish more than providing mere relief from the stresses of medical school applications. By providing students greater freedom to choose courses and strong encouragement to pursue an academic discipline unrelated to the medical sciences, it is supposed to provide the type of educational atmosphere that will result in a richer intellectual foundation for MD recipients. Ultimately, Brown officials hope, this will help produce physicians better equipped to cope with the rigors of their profession.

``It's easy to get lost in the theory of all this,'' admits David Greer, Brown's dean of medicine and the originator of the PLME idea, ``but we really want to produce physicians that are tangibly different from the standard product.''

Experts say the need for such ``next generation'' physicians has been underscored by numerous recent developments in the medical world. The innovation of life-sustaining technologies, for example, has brought with it a host of ethical questions that cross many disciplines yet, so far, bridge the gaps between few of them. Philosophers may ponder the morality of cross-species organ transplants or of the so-called ``heroic'' life-saving measures available to modern medicine. But economists and sociologists are expected to address the ticklish question of who should pay. The physician who is forced to employ the controversial measures, on the other hand, is often only required to decide whether or not their use is technically feasible.

The result, says Dr. Greer, is a cacaphony of unrelated conclusions. ``We get philosophers who don't know anything about medicine -- they start to quote St. Thomas and everyone's eyes glaze over -- and then we have doctors who give their opinions but really don't have anything to say,'' he observes. Generally, a major thrust is underway to train experts conversant in the nuances of medicine, ethics, and philosophy. It is these so-called bioethicists who might be expected to attack the multifaceted problems about the application of medical techniques that have been confronted in some recent celebrated cases. It is also this type of professional that Brown hopes to train as a matter of course.

In addition, Greer cites as a ``pragmatic argument'' for Brown's program the perception among many observers that some areas in the US are becoming glutted with physicians. While there may soon be, say, too many ear, nose, and throat specialists in Buffalo, he argues that it will be decades before society becomes saturated with physicians who are also trained as computer scientists. The same goes for MDs who, trained in languages and political science, might one day apply their expertise to international health issues.

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The university also hopes to produce personally better-rounded and, as Greer puts it, ``happier doctors'' through is PLME. This is no small concern in a profession that has recently experienced record-high levels of divorce, alcoholism, and suicide among its members. ``It means there's been a too narrow approach to things, that the `pre-med syndrome' has prevented a lot of people from being prepared to face the fact that medical practice is a very demanding profession,'' says Greer. ``That represents very poor preparation for the practice of medicine.''

Greer and his colleagues intend to avoid such pitfalls by removing the barriers between medical and premedical studies that have traditionally been in place. Many universities have programs that guarantee a small number of college freshmen a slot in medical school, but they also admit college seniors into their graduate programs as well. As a result, undergraduates with guaranteed slots who were supposed to be freed from the pressures of a premedical curriculum often end up taking the same courses as their conventional pre-med colleagues. ``There is a perception that certain courses will help you in medical school no matter how you've been admitted,'' says Moises Arriaga, a student in his third year at Brown's medical school.

Brown's solution has been to eliminate conventional admissions to the graduate medical school after this fall. That, officials there reason, will eliminate any vestiges of the ``pre-med syndrome'' among udergraduates and permit them an unhindered exploration of other academic pursuits.

While there necessarily will be a core of scientific courses that will be required of all students in the PLME, Greer says the details are still to be worked out. He says at this point, however, it is clear that the course mixture in any student's program will depend primarily on the student's interests.

``Obviously, biology majors will take more organic chemistry than art history majors,'' he says. ``How much organic chemistry do you need anyway?'' Greer doesn't know. The underlying argument of PLME is that physicians are not really trained in medical school anyway, but in the years of postgraduate training and internships that are usually taken for upwards of a decade afterward. This becomes truer as the pressure to specialize increases. So the purpose of medical school, the thinking continues, should be to prepare one for further training and the rigors of the future profession. ``No one teaches the spiritual factors of medical practice, the genesis of ethical principles, the purpose of life,'' he says. ``Instead we're just made to memorize all sorts of equations in physics that, within a few years, we can't possibly understand.''

The loftiness of PLME's objectives aside, Greer says he has drawn a lesson from his spiritual mentor, Robert Maynard Hutchins, who was chancellor of the University of Chicago while Greer attended medical school. Hutchins revolutionized many aspects of American higher education with his radical ideas about the integration of various disparate intellectural threads into one grand discipline.

``He was right about everything, but he was too far ahead of his time,'' Greer says, adding that the PLME will be continuously monitored and reviewed to insure that things remain on track and in touch with the demands of the ``outside'' world. ``All the rhetoric in the world isn't so helpful when you've got to sit down with Joe Smith from Lincoln, Neb., and help him prepare for the big future,'' he says. ``It's not enough just to be right.''

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