Reform of premed education under way

Medical educators are taking a fresh look at undergraduate courses that may deter students from medicine.

In 1910, Abraham Flexner’s examination of the state of American medical education led to widespread reforms in the way doctors are trained. Today, another evaluation is under way that could have equally far-reaching ramifications for future physicians.

The Committee to Establish the Scientific Foundation for Future Physicians, organized by the Association of American Medical Colleges and the Howard Hughes Medical Institute, is studying the standard premedical curriculum to make it more relevant to the practice of modern medicine.

Robert J. Alpern, M.D., dean and Ensign Professor of Medicine, the committee’s co-chair, said it took the committee only a single meeting to identify the problem: while science and medicine have changed dramatically since the days of Flexner, the premed curriculum has remained static. Organic chemistry, the bête noire of almost every premed student, is a required course although the relevance of some components of the course to medicine is marginal. At the same time, such crucial subjects as statistics, biochemistry and genetics aren’t required at the undergraduate level.

Another problem, Alpern said, is that the premed curriculum often serves as a gatekeeper to weed out students. “I’ve actually spoken to organic chemistry professors who pride themselves on being the ones who determine who should go into medicine,” he said.

The 19-member committee, drawn from both medical schools and undergraduate institutions, has been meeting for about a year and a half. It’s working on recommendations that will be presented in a report this year.

The key proposal, Alpern said, is to replace required courses with “scientific competencies”—the knowledge and habits of thought that a student should have upon entering medical school. “We want to get away from telling colleges, ‘You need to have a course in this or a course in that,’ ” he said. “We want to say, ‘These are the competencies someone should have.’ ”

Alpern anticipates that this approach will reduce the importance of organic chemistry in favor of biochemistry. Similarly, the mathematics curriculum will shift away from calculus and toward statistics. Alpern also hopes that professors will develop interdisciplinary courses that illuminate the medical relevance of premed coursework and that standardizing what new medical students should know will free medical school professors from having to teach to the lowest common denominator.

The impetus for revisiting the premed curriculum came from the National Research Council’s 2003 BIO 2010 report, which found that fewer American students are becoming research biologists—in part because of the premed requirements. “When premed students got tortured in organic chemistry, people thinking about careers in research biology got tortured along with them,” Alpern said.

Committee members plan to seek feedback from certain medical and undergraduate educators before disseminating the report to the undergraduate and medical school communities. The committee knows it will be easier for wealthy colleges to revise their curriculum to accommodate these changes.

In a parallel effort, a new committee has been formed to revise the MCAT, the aptitude test that students take for admission to medical school. The work of these two committees must be integrated for change to occur as it requires coordinated modifications in premed requirements, the MCAT and the undergraduate curriculum. Alpern predicts it will take some years before students see any changes, because directors of undergraduate programs will need to know how the MCAT will be revised before they can change their curricula.

“It’s not going to happen overnight,” he said, “but when it does, I think it will represent a major transformation in medical education.”

—Jennifer Kaylin

Online: Yale Netcasts
Robert J. Alpern: Vision for the School of Medicine

Dean of Yale College becomes third scientist named as provost

Last fall, during his final freshman address as dean of Yale College, Peter Salovey, Ph.D. ’83, exhorted members of the Class of 2012 to go their own way, to “say goodbye to what is familiar, even to what we have grown to love, and leave it for uncharted waters.”

He could have been giving himself a pep talk in the bathroom mirror. After four years as dean, a job he readily admits he loved, Salovey was offered the job of provost, the university’s chief academic officer after the president. “I’m delighted to have this new set of challenges,” he said, “but to walk away from something you love is a difficult thing to do.”

Salovey, the Chris Argyris Professor of Psychology and professor of epidemiology and public health, is Yale’s third consecutive provost to be chosen from the health-related sciences. He succeeds Andrew Hamilton, Ph.D., an organic chemist who left Yale to become vice chancellor of the University of Oxford in England, and Susan Hockfield, Ph.D., a neurobiologist who is now president of the Massachusetts Institute of Technology.

Salovey doesn’t think this is a coincidence. “There is no doubt that for Yale to remain in the top tier of universities, we have to strengthen science and engineering on both sides of campus,” he said. “This is an area of priority and has been for some years.”

The acquisition of West Campus, a former pharmaceutical company lab and office complex in neighboring West Haven and Orange, is critical to this effort, Salovey said, and he sees it as part of his new job to work with Michael Donoghue, Ph.D., the vice president for West Campus Planning and Program Development, to use that facility as an incentive to attract world-class researchers to Yale.

Noting his numerous research collaborations with faculty from the schools of medicine and public health (he was co-director of the Center for Interdisciplinary Research on AIDS for nine years), Salovey said he understands the challenges faced by the medical school faculty. “My lab has the same pressures,” he said. “We look for funding the same way. We share the same struggles.”

Salovey joined the Yale faculty in 1986 after receiving his undergraduate degree from Stanford and his Ph.D. from Yale. He was appointed dean of the Graduate School of Arts and Sciences in 2003. A year later, he was named dean of Yale College, where he presided over growth in international programs and financial aid changes. His research has focused on human emotion and health psychology. With colleague John D. Mayer, Ph.D., he developed a concept called “emotional intelligence,” the theory that just as people have a range of intellectual abilities, they also have measurable emotional skills that affect their success in life.

Salovey knows his own emotional intelligence will be tested in his new job. “The stereotype of the provost’s office is the guy who says no,” he said. “But I think it’s a mistake to assume that the role of the provost is to frustrate all good ideas, intentions and creativity of the faculty. I would like to think of it as the office that helps you shape your ideas, clarify your goals and manage your expectations so that we can be saying ‘yes’ at least as often as we say no.”

—J.K.

A physician’s gift supports research on pre-eclampsia and prematurity

Shortly before the end of World War II, a dying Albert S. McKern, M.A. ’13, M.D., turned to lawyers—fellow prisoners in a Japanese internment camp in Sumatra—and composed his will. His vacant land was to be developed, and property that he owned in Penang, Malaysia, where he had practiced as a physician and surgeon, was to be renovated and rented. Ten years after the death of his last child, the family’s holdings were to be sold and the money divided among three universities—Yale, where he had received a degree in engineering; the University of Sydney in Australia, where he had received his bachelor’s degree and studied theology; and the University of Edinburgh in Scotland, where he had received his medical degree.

Born in 1885 in Sydney, McKern came to Yale in September 1911 after deciding that theology was not for him because of his difficulties with public speaking. He earned a master’s degree from Yale, followed by a medical degree from Edinburgh in 1917. McKern then moved to Penang, where he built up both a successful medical practice and substantial real estate holdings. During the Japanese invasion in 1942, McKern was captured in Indonesia. He died three years later of dysentery.

Under the terms of McKern’s will, his family’s estate—$12 million—was to be used “for the sole and special purpose of establishing medical research scholarships for investigation into the causes, prevention and treatment of mental and physical pain and distress during pregnancy, labour and the puerperium.” McKern’s last surviving beneficiary died in December 1997, and the trust terminated a decade later.

Yale’s portion of McKern’s gift—about $4 million—will endow annual grants to those doing promising research on these issues. Charles J. Lockwood, M.D., the Anita O’Keefe Young Professor of Women’s Health and chair of obstetrics, gynecology and reproductive sciences, learned about the gift several years ago at a meeting with Andrew A. Calder, M.D., head of reproductive and developmental sciences at Edinburgh. Lockwood’s initial reaction was disbelief. “He’d had a few drinks and I thought he was exaggerating,” Lockwood said. Eventually the two began a discussion of joint work that might fulfill McKern’s dream.

“They have a very strong program,” he said of ob/gyn research at Edinburgh, citing the work done in prematurity and pre-eclampsia in particular.

Lockwood hopes to devise a joint strategy for using the money from the bequest during this academic year. Given McKern’s desire and the needs of the field, Lockwood sees prematurity research as an area of focus. “[Prematurity] is the leading cause of infant mortality in the United States, the leading cause of mental retardation, the leading cause of childhood blindness. It costs the U.S. economy around $28 billion a year in terms of health care-related resources. Preterm delivery is a national public health crisis.”

Funds from the bequest may also support a Yale-Sydney-Edinburgh scholarly exchange program and research on postpartum depression in the psychiatry department.

—Charles Gershman

Charles J. Lockwood : Yale Ob/Gyn—Research Updates and Clinical Advances

Yale team builds new search engine that retrieves images based on embedded text

In July a team of Yale scientists published a paper describing an innovative search engine with a new way of finding biomedical images. Search engines and websites already allow scientists to search for images based on titles and captions. “We are not aware of a biomedical search engine that can retrieve images by searching the text within biomedical images,” Michael O. Krauthammer, M.D., Ph.D., assistant professor of pathology, and colleagues wrote in their paper published in Bioinformatics.

The Yale Image Finder (YIF) lets researchers locate diagrams, graphs and other experimental figures based on text contained in the images. YIF, funded by a grant from the National Library of Medicine and accessible at http://krauthammerlab.med.yale.edu/imagefinder/, enables users to access more than 140,000 images from more than 34,000 papers published in open-access biomedical journals.

Krauthammer calls this new technology a major step in biomedical literature retrieval, as most important information exists in places other than image captions, which, until now, have been the primary targets of image search engines.

YIF functions by performing optical character recognition before making the images available for search. Users can restrict image queries to the text within the images, the image caption, the paper title, paper abstract, full text or any combination thereof. After submitting a query, YIF presents users with thumbnails of images. Once an image of interest is selected, YIF provides a high-resolution version of the image, along with the abstract, full text and other images from the associated paper.

“The idea is to augment text mining with image mining, with the idea that we can have a better understanding of a research article using automated means,” Krauthammer says. “I’ve felt that images are undervalued in terms of their representative quality and what type of information they can hold. In the future, we should be able to obtain even more information from the images, and get a pretty good understanding of what the paper is about.”

—C.G.

et cetera

Two grants advance public health

The School of Public Health has received a twofold boost in the form of an $11 million grant from the National Institute of Mental Health (NIMH) and a $10.7 million grant from the National Institute of Child Health and Human Development (NICHD).

The NIMH funding provides five years of support for HIV/AIDS prevention and health services at the school’s Center for Interdisciplinary Research on AIDS (CIRA). The grant from NICHD adds to a $15 million grant in 2007 to support Yale’s role in a national study that will follow 100,000 children from before birth to age 21 to improve understanding of the factors that contribute to their health and development.

The grant to CIRA follows an October 2008 report from the Centers for Disease Control and Prevention that revealed higher estimates of new HIV infections in the United States than previously calculated and emphasized the need for more rigorous study of interventions for HIV prevention.

—John Curtis

Yale pays $7.6 million in grants probe

Under the terms of a settlement reached in December, Yale will repay the federal government $7.6 million after an investigation of Yale’s accounting practices for research grants. The probe, which began in June 2006 and covered periods going back to 1999, was led by the U.S. Attorney’s Office on behalf of federal granting agencies, including the Department of Health and Human Services and the National Science Foundation.

President Richard C. Levin said that the university has “a clear obligation to comply with all regulations pertaining to the administration of federal awards.” He also acknowledged that federal regulations are sometimes burdensome, but noted that Yale receives more than $400 million in federal grants each year.

As a result of the investigation, Yale’s Office of Research Administration has developed training and education programs, published revised policies and procedures, implemented a Web-based reporting system, and designed procedures for the documentation and review of cost transfers.

—J.C.


			Originally published in Yale Medicine, Winter 2009. Copyright © 2009 Yale University School of Medicine. All rights reserved.