One of the most challenging aspects of medical school is to drink from the torrent—the fire hose—of scientific knowledge pumped down your throat while still remaining a sentient human being. And to remember that it was a desire to help other human beings that attracted you to medicine in the first place. The amount of information medical students are asked to assimilate is so enormous—so pantagruelian, to steal from the French doctor-turned-humanist Francois Rabelais—that it almost unavoidably turns idealistic young men and women into cold-purposed cyborgs, whose entire reason for being becomes the digestion of data.
Medical educators have for decades struggled to produce physicians who can not only process this ever-growing fund of knowledge, but who are also capable of evincing genuine compassion and empathy for the patients they apply it to. Many approaches have been tried to achieve this delicate balance. As readers of this blog are aware, courses in the field of narrative medicine help medical students maintain a humanistic perspective by requiring close reading of specific works of literature that stimulate the brain’s empathy centers, putatively located in the anterior cingulate cortex and amygdala.
Another possible way of assuring that medical trainees leave medical school with an ability to forge empathic connections with their patients is to select a limited number of students who already have this quality, in hopes that their humanistic impulses will be less prone to withering than those of hard-core science types. One medical school that has gone all in on this theory is the Mount Sinai School of Medicine in New York, with their Humanities and Medicine Early Acceptance Program, which “provides a path to medical school that offers maximum flexibility in the undergraduate years for students to explore their interests in humanities and social sciences at top liberal arts colleges and research universities.”
Thirty to thirty-five college sophomores are accepted annually into the program. To qualify, they are required to major in a humanities subject in exchange for not having to take physics or calculus, and for taking a reduced course load of organic chemistry. One year of undergraduate general chemistry and biology and one semester of organic chemistry remain mandatory for matriculation. Students admitted through this program are not permitted to take the Medical College Admission Test (MCAT). In 2009, there were 300 or so applicants to the program, with 34 students accepted.
Medical students entering Mount Sinai via the Humanities and Medicine Program performed in line with students accepted in traditional fashion, as assessed by class ranking, medical clerkship grades, standardized test scores, and the quality of residency positions obtained for post-graduate training. As described in a letter in the British medical journal The Lancet this month (Medoff, S. Correspondence. Lancet. 2010; 376: 1542), “Students in the programme this year have worked as professional actors, lived with shaman healers in Peru, taught English in Indonesia as Fulbright scholars, and pursued advanced degrees in classical music performance.” Mount Sinai’s web site states that they seek candidates who “have personal attributes that show promise for becoming a compassionate and humanistic physician.”
In other words, despite the explosion in basic science knowledge all medical students are expected to master, educators have become gun-shy about taking too many science nerds. The message of programs such as Mount Sinai’s is clear: Be first a human, then a doctor.