medical education in the United States
May 24, 2009 8:10 PM   Subscribe

Why do medical schools in the United States generally require a bachelor's degree before admission?

In other countries that I am familiar with, medical education starts after high school. How did the United States come to have this current system (college and then med school)? Do any other countries have a system similar to the United States?
posted by esnyder to Education (14 answers total) 1 user marked this as a favorite
 
Canadian schools require a Bachelor's degree as well.
posted by Midnight Rambler at 8:16 PM on May 24, 2009


It starts after high school here, too. That bachelor's degree usually is in Pre-Med, which basically means it's the first four years of medical school. The med schools then offer the last half or so of the medical education.
posted by Chocolate Pickle at 8:24 PM on May 24, 2009


The Wikipedia medical school article does a pretty good job of laying down the differences between countries. It looks like several countries (UK, Ireland, Australia, South Korea) are at least partially transitioning to a US-style postgraduate program from the undergraduate direct entry program.
posted by zsazsa at 8:25 PM on May 24, 2009


That's not necessarily true, many medical schools only strongly encourage bachelor's degrees but all medical schools have prerequisite courses that you must take. But to answer the question I think it mainly has to do with our early education system pretty much sucking. I'm reminded all the time about how easy my high school course load was compared to students in Korea and it's really true, high school education in the US is a joke. Even the best of high school graduates would have an extremely difficult time grasping the courseload of medical school, hell most college graduates have an extremely tough time with it. College performace is a big indicator of whether or not this person can cut it in medical school, anyone can cut it in high school so how are the admissions people supposed to choose?
posted by BrnP84 at 8:28 PM on May 24, 2009 [1 favorite]


Best answer: The 1910 Flexner Report [full text - pdf; NPR story] established the principle of the four-year medical course, preceded by at least two years of college education with a focus on science. The MCAT followed not long after. There are still a (small) number of US institutions that offer combined BS/MD courses which run between six and eight years.
posted by holgate at 8:35 PM on May 24, 2009 [2 favorites]


Best answer: The US trend towards requiring a post-secondary education before entering medical school began in the early 20th century. Johns Hopkins and Harvard, two of the preeminent medical schools in the country, began requiring it in 1898 and 1901, respectively. From the linked 1910 Atlantic article:
Early in the [eighteen-]seventies the new president of Harvard College startled the bewildered faculty of its medical school into the first of a series of reforms that began with the grading of the existing course, and ended in 1901 with the requirement of an academic degree for admission. In the process, the university obtained the same sort of control over its medical department that it exercises elsewhere. Toward this consummation President Eliot had aimed from the start; but he was destined to be anticipated by the establishment in 1898 of the Johns Hopkins Medical School on the basis of a bachelor’s degree, from which with quite unprecedented academic virtue no single exception has ever been made.
The move to higher and higher admission requirements rapidly took hold in other schools:
In the sixteen years that have since elapsed, fourteen more institutions have actually advanced to the basis of two or more years of college work; others have undertaken shortly to do so. Besides these, there are perhaps a dozen other more or less efficient schools whose entrance requirements hover hazily about high-school graduation.
posted by jedicus at 8:36 PM on May 24, 2009


Response by poster: Midnight - Thanks. I had forgotten about Canada.

zsazsa - Thanks for pointing me to that article.

BrnP84 - I definitely believe that that students coming out of the average American secondary education are not prepared for the study of medicine. But I doubt this is the reason that the education system is structured as it is.

True, college as a pre-med is basically like the first bit of med school in other countries. Can anyone find any historical information about when/why Canada and the US developed their current set-up?

And yes, I realize actually are some schools, at least in the United States, that have a shortened and bundled college+med school program.

Thanks for the input!
posted by esnyder at 8:43 PM on May 24, 2009


For Canada, look here and here. Not all Canadian schools require a bachelors. Some only ask for 2-3 years. See stats.
posted by acoutu at 10:30 PM on May 24, 2009


Another barrier to entering the profession, securing greater earnings for the current members at the cost of aspiring doctors and the public...

/cynicism
posted by the christopher hundreds at 11:19 PM on May 24, 2009 [1 favorite]


It's not uncommon for doctors to have studied something not directly related to medicine in undergrad. I've personally seen doctors with undergraduate degrees in humanities, anthropology, engineering, and art history. Allowing people to decide after their college education, I think allows for a more diverse pool of doctors, and perhaps a more mature one, since they aren't all just following a set track started after high school.
posted by ishotjr at 11:44 PM on May 24, 2009 [1 favorite]


A major theme in the US educational system is constant paths to redemption. Unlike other countries (Germany comes to mind), we avoid letting kids completely shut out career opportunities as long as possible. Even the vocational course in HS is being phased out in some places so that everyone gets a "college prep" course. I think the idea of an 18-year-old committing to a medical career is incompatible with that ethos of always having options. Schools want students to get a general education up through sophomore year or so before they can even begin to specialize.

I'm not at all in favor of this, but it is a theme I have seen throughout the educational system. Options, options, options.
posted by parkerjackson at 6:12 AM on May 25, 2009 [1 favorite]


Re: Canada: the situation gets a little stickier when it comes to CEGEP (grade 12, or senior year, and some college, all rolled into one). Here's what happened to a friend of mine: he moved out of Ontario after grade 11 to attend a CEGEP in Montreal. He spent 2 years in CEGEP, then applied to medical school. He didn't get in, but a lot of people from his CEGEP, all the same age as him, did. They'd be far too young to attend American medical schools. Also, Quebec schools tend not to require the MCAT, as it's not readily available in French. So Canada is actually run on an 'in-between' system, depending on what province you're in: it's always essentially the American system, but with a twist.
posted by flibbertigibbet at 8:40 AM on May 25, 2009


My impression is that it's just another way to help limit the already-huge applicant pool. To give a student a medical education is an enormous amount of work. So, The_Christopher, while it would be great if everyone could just get into med school, who would actually support and teach all the extra students? Where would all the extra residencies come from? I know that medical schools in the US are doing everything they can to increase class size, but when you add that to the fact that a lot of these schools are losing money . . . if you are cutting your cadaver budget while increasing the first year class size, at some point the quality of education is going to suffer. Then you're graduating a bunch of crappy doctors, which is useless. There has to be a way to weed people out, and having a degree is just one of many logical screens. Even if schools did allow people without degrees to apply, they would still have more than enough applicants with degrees to fill the spots.
posted by lblair at 10:05 AM on May 25, 2009


lblair: You're right that there are limited resources to educate future MDs. I'm not necessarily advocating an open doors policy at medical schools. I just believe that the requirement of a bachelor's degree is a burden placed on students by entrenched interests without regard to the costs to society or the aspiring med student. A college degree may be a logical screen, but it's one that costs an applicant four years of her life and tens of thousands of dollars. Surely a better arrangement could be made at a smaller cost, if even borne entirely by the applicants... The same is true in the legal profession (and many others, I'd guess). A smart high school grad could handle law school...
posted by the christopher hundreds at 12:04 AM on May 27, 2009


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