Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century after the Flexner Report

Overview

This book raises fundamental questions about the propriety of continuing to use a premedical curriculum developed more than a century ago to select students for training as future physicians for the twenty-first century. In it, Dr. Donald A. Barr examines the historical origins, evolution, and current state of premedical education in the United States.

One hundred years ago, Abraham Flexner's report on Medical Education in the United States and Canada helped establish the modern...

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Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century after the Flexner Report

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Overview

This book raises fundamental questions about the propriety of continuing to use a premedical curriculum developed more than a century ago to select students for training as future physicians for the twenty-first century. In it, Dr. Donald A. Barr examines the historical origins, evolution, and current state of premedical education in the United States.

One hundred years ago, Abraham Flexner's report on Medical Education in the United States and Canada helped establish the modern paradigm of premedical and medical education. Barr’s research finds the system of premedical education that evolved to be a poor predictor of subsequent clinical competency and professional excellence, while simultaneously discouraging many students from underrepresented minority groups or economically disadvantaged backgrounds from pursuing a career as a physician. Analyzing more than fifty years of research, Barr shows that many of the best prospects are not being admitted to medical schools, with long-term adverse consequences for the U.S. medical profession.

The root of the problem, Barr argues, is the premedical curriculum—which overemphasizes biology, chemistry, and physics by teaching them as separate, discrete subjects. In proposing a fundamental restructuring of premedical education, Barr makes the case for parallel tracks of undergraduate science education: one that would largely retain the current system; and a second that would integrate the life sciences in a problem-based, collaborative learning pedagogy. Barr argues that the new, integrated curriculum will encourage greater educational and social diversity among premedical candidates without weakening the quality of the education. He includes an evaluative research framework to judge the outcome of such a restructured system.

This historical and cultural analysis of premedical education in the United States is the crucial first step in questioning the appropriateness of continuing a hundred-year-old, empirically dubious pedagogical model for the twenty-first century.

Johns Hopkins University Press

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Editorial Reviews

JAMA - Dennis Rosen
Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion and framing it to allow the current model of premedical education to be rethought in a way that will conform to the needs of the profession and to the needs of society as a whole.
JAMA - John L. Zeller
Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion.
Journal of the History of Medicine and Allied Medicine
Barr’s is a multifaceted book, so a variety of disciplines will find various chapters useful to their goals. Teachers of education policy will find the sections on educational disparities and pedagogical innovation of great interest; while medical historians and medical humanities programs will enjoy the chapters on the history of and research on premedical education. Clinical Research training programs will find the last chapter useful as a case study in protocol articulation.
Doody's Review Service
Reviewer: Benita D Wolff, M.Ed.(University of Iowa Carver College of Medicine)
Description: This book challenges the effectiveness and necessity of the current premedicine curriculum. At issue is the "weed out" impact of the current curriculum on students, especially students from groups underrepresented in medicine.
Purpose: It examines the results of a five-year study of Stanford and University of California-Berkeley students designed to explore the impact of key premedicine courses (i.e. chemistry, physics, biology) on student persistence to enter medical school. The author also provides a history of how the existing premedicine curriculum was established and provides recommendations for curricular changes that could increase the number of underrepresented individuals who enter the medical profession. The author articulates thought-provoking ideas at a time when educators, administrators, and policy makers nationwide are working to fix the leaking premedicine pipeline for minority individuals and individuals from groups historically underrepresented in medicine.
Audience: This book will be useful for curriculum experts, diversity leaders, premedical advisors, medical school administrators, policy makers and others responsible for preparing students for success in medical school.
Features: Readers will gain an understanding of the structure and history of the current premedicine curriculum from this book. The author uses the results of a five-year study to explore problems with the current curriculum, particularly for underrepresented minority students. The author challenges readers to reconsider the current process for preparing students for medical school and offers several examples of nontraditional premedicine preparation programs that have proven successful. The book concludes with recommendations for renewing the current premedicine curriculum.
Assessment: This book will inform my work related to increasing the pipeline of premedicine students, especially minority students and those from other underrepresented groups.
From The Critics
Reviewer: Benita D Wolff, M.Ed.(University of Iowa Carver College of Medicine)
Description: This book challenges the effectiveness and necessity of the current premedicine curriculum. At issue is the "weed out" impact of the current curriculum on students, especially students from groups underrepresented in medicine.
Purpose: It examines the results of a five-year study of Stanford and University of California-Berkeley students designed to explore the impact of key premedicine courses (i.e. chemistry, physics, biology) on student persistence to enter medical school. The author also provides a history of how the existing premedicine curriculum was established and provides recommendations for curricular changes that could increase the number of underrepresented individuals who enter the medical profession. The author articulates thought-provoking ideas at a time when educators, administrators, and policy makers nationwide are working to fix the leaking premedicine pipeline for minority individuals and individuals from groups historically underrepresented in medicine.
Audience: "This book will be useful for curriculum experts, diversity leaders, premedical advisors, medical school administrators, policy makers and others responsible for preparing students for success in medical school. "
Features: "Readers will gain an understanding of the structure and history of the current premedicine curriculum from this book. The author uses the results of a five-year study to explore problems with the current curriculum, particularly for underrepresented minority students. The author challenges readers to reconsider the current process for preparing students for medical school and offers several examples of nontraditional premedicine preparation programs that have proven successful. The book concludes with recommendations for renewing the current premedicine curriculum. "
Assessment: This book will inform my work related to increasing the pipeline of premedicine students, especially minority students and those from other underrepresented groups.
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Product Details

  • ISBN-13: 9780801894169
  • Publisher: Johns Hopkins University Press
  • Publication date: 3/2/2010
  • Pages: 226
  • Product dimensions: 6.20 (w) x 9.00 (h) x 1.10 (d)

Meet the Author

Donald A. Barr, M.D., Ph.D., is an associate professor at Stanford University in the Departments of Pediatrics and Sociology. He is the author of Introduction to U.S. Health Policy, second edition, and Health Disparities in the United States, both also published by Johns Hopkins.

Johns Hopkins University Press

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