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Rethinking weed-out pre-med classes
Illustration by Tuesday Hadden
On Oct. 3, the New York Times published an article about the firing of Dr. Maitland Jones Jr., former professor of organic chemistry at NYU. Following a brutal spring semester in which the midterm average reportedly “hovered around 30 percent,” growing student disaffection resulted in the creation of a petition demanding a change in teaching strategy. The article goes on to describe how, despite Jones’ disagreements, the university abruptly terminated the professor’s contract before the oncoming fall semester.
Simple, right? Not if the commentariat had anything to do with it.
The article immediately spawned several responses in the pages of the Times itself, not to mention excoriation by the Editorial Board of Washington Square News, NYU’s student newspaper. Publications from the Baltimore Sun to Forbes chimed in with their own perspectives. Even Jones defended himself in the pages of the Boston Globe.
Every commentator pounced on the chance to read the tea leaves. What could have explained the inexplicable drop in standards? Was it the slackening of discipline during remote learning? Perhaps it was Jones’ inflexible teaching style. Maybe the course disproportionately impacted the underprivileged. Every suggestion came with another contradictory policy prescription, whether it was to give students more power or less power or raise the grade requirements or lower the requirements or even just do nothing at all.
However, reading through all the different perspectives, I can’t help but feel that all of these commentators have missed something. Why do they keep talking like these students are lacking something? It betrays a disheartening dearth of imagination — as if this were merely an issue of falling grades, and our only solution is either giving students something they don’t have (support, time, resources) or finding students who already have what they need to succeed (skill, talent, intelligence).
These “solutions” miss something fundamental about how the premedical curriculum works, and thus fail to address the root of the problem. To understand how college actually works, we need to review how college is supposed to work.
The organic chemistry class is required as part of NYU’s pre-medical track. As a weed-out class, it is made intentionally difficult to winnow the large pool of prospective clinicians to a select few. Ideally, the remaining pool of candidates, having proven their competency in the crucible of organic chemistry, represent worthy applicants to medical school. The implication, of course, is that those who don’t make it are not cut out for medical school. But as deceptively simple as this logic appears, its flaws are incredibly obvious.
Firstly, why do schools (and, yes, WashU is included in this) find it necessary to cut down the number of medical school applicants? After all, research already shows that the United States healthcare system suffers from a devastating shortage of doctors. According to the Association of American Medical Colleges, we will be short by more than a hundred thousand family doctors, surgeons, and medical specialists by 2034. We aren’t producing enough doctors — so why are we so keen on constraining supply?
It all comes down to a quota set by the federal government in 1981 out of fears of physician surplus. Spurred on by a report by the Graduate Medical Education National Advisory Committee, federal funding to medical training programs dried up in the hopes of preventing a glut of overtrained and underemployed medical professionals. Medical schools complied, implementing restrictions on the creation of new medical schools and the expansion of existing class sizes that wouldn’t end until 2005. Yet we know now that low supply is the issue. Weed-out classes no longer need to be a bellwether for getting into medical school. If anything, they are counterproductive to the goal of graduating more doctors every year.
But maybe we should avoid reaching premature conclusions. Isn’t organic chemistry crucial to a doctor’s education? Isn’t it important that we maintain the highest possible standards for the people who will hold our lives in their hands, and aren’t weed-out classes simply the harsh gatekeepers of these standards?
The facts say otherwise. Research has already well established that weed-out classes disproportionately exclude underrepresented populations, which can only mean that these classes are filtering for prior preparation, not the skills to become a doctor. And what happens to those who are forced to switch out? In a study by a group of STEM education reformers, the prognosis was grim: switchers report losing interest in science altogether, suffering severe blows to confidence, or abandoning lifelong pursuits.
The practice could be defended if this was the price we must pay for high-quality doctors. Maybe we really do have to devastate entire cohorts of prospective STEM students just to find the ones worthy of medical school.
And yet, research has found that personality, not GPA, can be a better predictor of medical school success. A study conducted on Belgian medical students published in 2010 discovered that “if someone is at the 15th percentile of [cognition] but at the 95th percentile of conscientiousness, chances are that the student is going to make it.”
NYU’s pre-health track does not require a course on conscientiousness. It doesn’t even require a course on ethics. Neither does WashU’s, for that matter.
But maybe you still object to what I’m saying. Even if organic chemistry is not an ideal part of the premed curriculum, shouldn’t we at least expect our future doctors to manage to pass the course? Doesn’t the fact that so many students failed this year prove they just aren’t smart enough to be doctors?
You’d be wrong yet again. According to an NYU promotional news release, the class of 2026 represents the university’s most selective class yet, with a mere 12% of applicants qualifying (the College of Arts and Sciences, which hosts the biology major, had an even lower acceptance rate at 7%). Its median SAT score? 1550, representing the 99th percentile of test-takers — in other words, the cream of the crop.
Either we must accept that the top 1% of students in the nation are somehow unworthy of becoming doctors because they cannot reliably identify Lindlar’s reaction, or this system is fundamentally nothing short of a farce. If anything, it seems little more than a game designed to exclude passionate students and minority applicants in the midst of a dire shortage of doctors by testing them on material that one education reformer has called “irrelevant to being a competent physician,” all because of miscalculations 40 years ago. The most ridiculous aspect of all of it is that these students have already categorically proven they belong, persisting through ever-tightening admissions criteria cast on the backdrop of the feverish culture surrounding college admissions. In the end, they are prevented by a single course, even if education experts have been questioning its relevance to medicine itself for decades. Combine all of this with the context of the surge in tuition prices and you have a recipe for the sheer absurdity of our current conception of medical study in America.
It’s clear that this is a serious problem facing our education and medical systems. But, as I have been writing this article, I have had to ask myself the same question over and over: why am I so angry about this? It’s a big problem, sure, and yet even researching this topic spawns a passionate, irrational outrage in me.
I haven’t been entirely honest. I have a personal stake in all of this.
I’m a prospective biology major myself, and I must admit that the stereotypes and jokes about us freshmen are true. They say that a leaf falls from a tree outside Olin Library for every freshman who decides to go premed — frankly, the attendance at my morning General Chemistry lectures is evidence that that’s true. If guessing people’s majors was a test, you could probably get a passing grade by just assuming everyone wants to be a doctor. And while I don’t have any ambitions to become a doctor myself, so many of my friends and peers have chosen that path.
As amusing as the jokes are, though, I can only look on in horror at the incoming wave of premed students. The statistics don’t lie: a large proportion of them will be crushed in the coming semesters. They’ll drop out of their field, utterly disillusioned. They may never regain the confidence they once had. Far too many of them will be underprivileged, and some may be the very first people in their families to go to university. The vast majority could have had successful careers as clinicians. I’ll have to watch as all of them will give up their dream of being a doctor.
I have heard the all-too-frequent rejoinder that “this is just the way things are,” that every freshman gets their dreams broken, one way or another. But that’s what’s so tragic about it all. This isn’t the inevitable consequence of being confronted by harsh reality. This is the inevitable consequence of getting chewed up and spit out by a meaningless game built on an administrative mistake and sustained by the collective delusion that organic chemistry is some inviolable keystone of medical education.
I’m sure I’m being naïve in my preachy, self-righteous “defense” of dreaming. But I think you’d be just as naïve to say that the system is working as it should be, or that the system represents anything close to an ideal education. Students haven’t failed the premed curriculum, nor has the curriculum failed its students — rather, the curriculum itself is a failure.