WHITHER THE FUTURE?
OR “Is calculus really required for medical practice?”
WARM-UP
Or, “You will definitely want to form groups of five. Trust me.”
DIFFERENTIATE
y = (3x
2
+1)
COMPUTE
Limit
(x∞)
100
2
(x +5)
SOLVE
• As illustrated in Fig. 2 below, an object of mass m = 2.0 kg is pulled along a
surface by a horizontal force F of 12 N to the right a distance s of 4.0 m. The
coefficient of friction between the object and the surface is 0.5. Find the
work done by (a) F, (b) the normal force FN, (c) the weight mg of the object,
(d) the frictional force f, (e) the net force.
SOLVE
IT STARTS WITH FLEXNER
THE HISTORY OF AMERICAN MEDICAL SCHOOL
• Started as supplement to apprenticeships (1600s-1700s)
• After training sought out additional learning at European hospitals
• Philadelphia begins to offer similar training, organizes first school (1700s)
• Joined by King’s College (New York), Harvard College, Dartmouth College
• Proprietary schools debut in Maryland (1800s)
• Apprenticeship system declines education shifts to classroom (1800s)
• “Since that day medical colleges have multiplied without restraint, now by
fission, now by sheer spontaneous generation.”
• 457 schools started in US and Canada, 155 extant during time of report
HISTORY CONTINUED (SO DISMAL)
• “These enterprises—for the most part they can be called schools or institutions only
by courtesy—were frequently set up regardless of opportunity or need.”
• “Wherever and whenever the roster of untitled practitioners rose above a half a
dozen, a medical school was likely at any moment to be precipitated.”
• “A hall could be cheaply rented…occasional dissections…a box of old bones...other
equipment there was practically none. The teaching was, except for a little
anatomy, wholly didactic.”
• “Schools were essentially private ventures, money-making in spirit and object. A
school that began in October would graduate a class the next spring.”
• “Income was divided among the lecturers, who reaped a rich harvest.”
• “In the entire United States…[on] average one doctor for every 568 persons…many
small towns with less than 200 inhabitants each have two or three physicians!”
HISTORY CONCLUDED
(HE SURE LIKED JOHNS HOPKINS)
“Johns Hopkins Medical School…was the first medical school in America of
genuine university type…well equipped laboratories conducted by modern
teachers, devoting themselves unreservedly to medical investigation and
instruction, and with its own hospital, in which the training of physicians and
the healing of the sick harmoniously combine to the infinite advantage of
both.”
CONCLUSIONS &
RECOMMENDATIONS
• Medical curriculum heavily relies on biology, chemistry, and physics
• Admission must require “competent knowledge” in these fields
• “It is immaterial where the student gets the introduction”
• Two years of college = minimum
• Fundamental sciences not enough
• Practitioner needs “insight and sympathy”
• Requires a “varied and enlarging cultural experience”
• “Society relies [on physicians] to enforce the conditions that prevent disease and
make positively for physical and moral well-being”
TODAY…SORT OF?
Biology
Physics
General
Chemistry
English
Organic
Chemistry
TODAY…NO, REALLY.
Illustration redacted (usage rights)
…AND USUHS
Illustration redacted (usage rights)
COMPETENCIES
Or, “Why the change?”
AAMC-HHMI
SCIENTIFIC FOUNDATIONS FOR FUTURE PHYSICIANS
• AAMC HHMI panel examined natural science competencies needed to
practice medicine
• Recommended move from static prerequisite courses to evolving
competencies
• Recommend undergraduate institutions move to interdisciplinary and
integrative science courses
• MCAT will begin testing for these competencies in 2015
THE NATURAL SCIENCE COMPETENCIES
• E1: Apply quantitative reasoning and appropriate mathematics to describe
or explain phenomena in the natural world
• E2: Demonstrate understanding of the process of scientific inquiry and
explain how scientific knowledge is discovered and validated
• E3: Demonstrate knowledge of basic physical principles and their
applications to the understanding of living systems
• E4: Demonstrate knowledge of basic principles of chemistry and some of
their applications to the understanding of living systems
COMPETENCIES, CONTINUED
• E5: Demonstrate knowledge of how biomolecules contribute to the structure
and function of cells
• E6: Apply understanding of principles of how molecular and cell assemblies,
organs, and organisms develop structure and carry out function
• E7: Explain how organisms sense and control their internal environment and
how they respond to external change
• E8: Demonstrate an understanding of how the organizing principle of
evolution by natural selection explains the diversity of life on earth
COMPETENCIES, EXPANDED
• E5: Demonstrate knowledge of how biomolecules contribute to the structure
and function of cells
• 2. Demonstrate knowledge of the principles of chemical thermodynamics and
kinetics that drive biological processes I the context of space and time
Examples
• Identify the six major types of biochemical reactions
• Distinguish different types of enzyme control
• Explain how membrane gradients and electron transport act to generate and store
energy
• Explain how glucose transport across epithelia depends on the sodium concentration
gradient
• Describe the role of the Na-K-ATPase in the maintenance of the resting membrane
potential of cells
• Etc.
BEHAVIORAL AND SOCIAL SCIENCE
COMPETENCIES
• Two informing reports
• IOM Improving Medical Education: Enhancing the Behavioral and Social
Science Content of Medical School Curricula (2004)
• AAMC-HHMI Behavioral and Social Science Foundations for future physicians
(2011)
• Recognition that natural science competencies “necessary but not
sufficient”
• Reminiscent of Flexner’s “varied and enlarging cultural experience”
MCAT2015
• MCAT last revised 1991
• MR5 Committee formed in 2008 to review test in light of evolving needs
• Balanced natural, social, and behavioral science needs with critical analysis
and reasoning skills
• Currently undergoing validity testing
• Will go live in 2015, current freshman are taking coursework in preparation for
THIS examination
THE NEW TEST
Biological &
Biochemical
Foundations of
Living Systems
Chemical &
Physical
Foundations of
Biological
Systems
Psychological,
Social, &
Biological
Foundations of
Behavior
Critical Analysis
& Reasoning
Skills
Biological &
Biochemical
Foundations of
Living Systems
Concept 1
Concept 2
Concept 3
•Biomolecules have
unique properties that
determine how they
contribute to the
structure and function
of cells, and how they
participate in the
processes necessary
to maintain life.
•Highly-organized
assemblies of
molecules, cells, and
organs interact to
carry out the functions
of living organisms.
•Complex systems of
tissues and organs
sense the internal and
external environments
of multicellular
organisms, and
through integrated
functioning, maintain
a stable internal
environment within an
ever-changing
external environment.
Chemical & Physical
Foundations of
Biological Systems
Concept 4
• Complex living
organisms transport
materials, sense their
environment, process
signals, and respond
to changes using
processes that can be
understood in terms of
physical principles.
Concept 5
• The principles that
govern chemical
interactions and
reactions form the
basis for a broader
understanding of the
molecular dynamics
of living systems.
Psychological,
Social, & Biological
Foundations of
Behavior
Concept 6
Concept 7
Concept 8
Concept 9
Concept 10
•Psychological,
socio-cultural,
and biological
factors
influence the
ways that
individuals
perceive,
think about,
and react to
the world.
•Psychological,
socio-cultural,
and biological
factors
influence
behavior and
behavior
change.
•Psychological,
socio-cultural,
and biological
factors
influence the
way we think
about
ourselves and
others.
•Cultural and
social
differences
influence wellbeing.
•Social
stratification
and access to
resources
influence wellbeing.
SCIENTIFIC INQUIRY & REASONING SKILLS (SIRS)
TESTED IN THE BBFLS, CPBS, AND PSBB SECTIONS
1
Knowledge of Scientific Concepts &
Principles
2
Scientific Reasoning and Problem Solving
3
Reasoning About the Design
and Execution of Research
4
Data-based and Statistical Reasoning
27
Critical Analysis & Reasoning Skills
Passages from humanities* discuss topics in:
• Architecture
• Philosophy
• Art
• Popular Culture
• Dance
• Religion
• Ethics
• Studies in Diverse
• Literature
• Music
Cultures
• Theater
• *Specific knowledge of these disciplines is not required for CARS section
IT ENDS WITH USUHS
It started with Flexner, but…
OUR VISION
The F. Edward Hébert School of
Medicine is the Nation's medical
school, recognized as the leader in the
education of physicians and scientists
to care for those in harm's way in a
rapidly evolving global frontier
WHAT DO WE NEED TO GET FROM HERE
(ADMISSIONS) TO THERE (INDEPENDENT PRACTICE)?
• Do we need to move to competency based admissions?
• How do we assess incoming competencies?
• Should we require any particular set of courses before students matriculate
to the School of Medicine?
• What courses would best prepare students to succeed in our curriculum and
fulfil our unique vision?