In the Garden of STEM

"April showers bring May flowers," is a common expression in the midwest of the United States. Those April showers also bring May weeds. The state of Illinois lists the dandelion as an official weed. Dandelions are particularly pernicious for homeowners as they have evolved to bring joy to children. When the dandelion flower turns to seeds, it looks like a cotton ball. The gentle blowing of a child's breath sends the seeds floating on the wind like summer snow to spread throughout your yard and your neighbors' yards. Homeowners spend countless hours either pulling these weeds from their lawn or spreading weed killer.

I often think of the dandelion when I hear college students discuss their experiences with premedical science classes. I look upon those students and wonder whether they are a medical dandelion or a medical flower. Built into the core of premedical education is the notion that students who do not have the aptitude for medical school should be counseled out of notions of continuing their medical education. In other words, courses should be designed to weed these students from the garden of STEM. These courses are commonly known as weed out classes. This core characteristic of premedical education dates back to a 1950s medical education report: "Effort should be made as early in the student's college career as possible to determine whether, on the basis of personality, character, motivation, and academic performance, he is qualified to go into medicine. If it is decided he is not qualified, then every intelligent device, including aptitude and interest tests, should be used to persuade him to reevaluate his professional objective." (1953 Survey of Medical Education, p. 11)

What do these medical dandelions look like? At Stanford University, as well as many other universities, medical dandelions are most likely women, African American, and Hispanic. Caucasian males are least likely to become medical dandelions. Given that there is no evidence to suggest that women, African Americans, and Hispanics are inherently inferior doctors, there must be something wrong with what we conceive to be important in preparing students for medical school.

Every weed, pest, and invasive species has a place on Earth where they belong and are treasured. The dandelion comes from Eurasia. It was brought to North America by European immigrants. The dandelion has many positive attributes. In the garden, the dandelion helps other plants by making nutrients available, attracting pollinators, and enhancing the process of fruit ripening. In the kitchen, the dandelion is used to make salad, wine, coffee, and as an ingredient in root beer. In medicine, the dandelion has been used as an herbal remedy to treat infections, liver problems, and urinary difficulties. Thus, unbeknownst to many homeowners, there are places on Earth that grow the dandelion on purpose for sustenance and medical treatment.

In medical practice, empathy is a practice that patients highly value from their doctors. It is the ability to relate to another person on an emotional level. Since the vast majority of time we need to see a doctor, we are in a heightened emotional state, it is greatly appreciated to be cared for by someone who understands what we are going through. However, empathy is another one of those dandelions that is weeded from premedical education. Several studies have found that performance in the weed out science classes is actually negatively correlated with empathy. One study (p. 123) concluded that: "students with high achievement in many components of the curriculum tend to have personality profiles that seem inappropriate for their chosen careers as physicians."

About 90% of medical schools follow this paradigm of premedical education requirements. The lack of empathy in the medical profession is well portrayed in a 1991 movie called The Doctor, starring William Hurt. It is based on the true story of a surgeon who made fun of doctors who showed empathy, until he contracted throat cancer himself and got to experience medicine from the patient's perspective. It changed the way he viewed the role of empathy in medicine. It would be nice if medical schools and premedical education embedded empathy into the core of their education programs.

One notable example of university that highly values personality characteristics is the DeGroote School of Medicine at McMaster University in Canada. Entrance to their program is not determined by how well students did in the weed out science classes. Instead, roughly one-third of the entrance score is based on overall GPA, regardless of major, one-third is based on a verbal reasoning score, and one-third is based on a personality assessment. Ranking on these scores is used to select for an on-site interview, which focuses on personality characteristics. Entrance to the medical school is based on the combination of both general academic strengths and personality characteristics. The result is that roughly 10% of the class comes from majors outside of science, such as the humanities, business, education and journalism. In the end, a McMaster student's undergraduate field of study does not predict the quality of their performance as a doctor.

Diversity matters in ecology and it matters in education. Declaring a plant as a weed based on one characteristic eliminates consideration of the variety of benefits that it has for the ecosystem. Likewise, weeding out premedical students based on only one of the characteristics of good physicians diminishes our access to individuals who are superior on many other qualities that make a good physician. I wish that universities would alter their selection criteria to focus on what actually matters for any given profession instead of using one yardstick to weed out the very qualities that we value.