When I dropped out of medical school in 2007, it happened in two stages: the first, administrative and fairly straightforward; the second, emotional and more complex.
When I made the decision to drop out, I was a 20-year-old medical student at Tehran University, finishing up my second year. (In Iran, you start medical school directly after high school and study for seven-and-a-half years.) A year later, I enrolled as a freshman at MIT. Logically speaking, I could have done pre-med and gone on to medical school in the US. This stage could have been merely an administrative change. I was swapping my school and country, not the ultimate goal of becoming a doctor.
However, when I started at MIT, I was utterly disappointed with the pre-med culture and requirements—as well as the way biology was taught—even at this top technical school.
If you are not familiar with pre-med culture, here is my take on it: As a pre-med student in the US, you generally have to take two years worth of courses and requirements as prescribed by the medical schools. While some of these are useful, and certainly relevant to your career as a doctor (like introductory biology, or experience shadowing a doctor), the requirements themselves are somewhat strict. Worse, medical school admissions committees obsess over grades in those particular courses.
Students worry about taking those classes with others who might be smarter (stressing over how they might affect the curve), picking professors by how many As they hand out, and other concerns that are not really relevant to their medical goals. What many don’t really think about is what actually interests them. In fact, my first point of departure from the pre-med track happened during my second semester at MIT, when I decided to enroll in a more difficult offering of electromagnetic physics, despite being strongly advised by the pre-med counseling office not to do so. They were worried about the higher risk of a B grade. I refused to take the advice, as I considered my learning experience more important than the possibility of getting a grade that would mark me as “about average.” (I did get a B in the end, with no regrets.)
In my opinion, this approach selects for the wrong type of doctor—a shallow and competitive one. A doctor who has not learned how to make mistakes and learn from them. A doctor who is never given the chance to challenge herself, take risks, discover her real strengths and weaknesses.
Honestly, I think a future surgeon would benefit much more from taking a sculpture or anatomical drawing class, a fossil analysis lab, or even acting, than, say, differential calculus. The current pre-med system in the US just doesn’t leave much room for broader, interdisciplinary paths to a career in medicine. After all, aspiring doctors will acquire the critical skills once they get to medical school—so why not ease the requirements and let them explore potentially complementary knowledge or skill sets? I assure you, 90% of med-school graduates can’t recall even a third of what they learned in undergraduate organic chemistry. But an improv course might help them learn to think on their feet.
Some schools have started offering BS-MD programs, and I suspect the reasoning behind it is to free students from the unnecessary strictures of pre-med, and allow for broader academic exploration on the way to medical school. It has its own downsides —for instance, accepting the students at 18 with less knowledge of their potential as a doctor or genuine interest in medicine (and an early commitment for a student)— but at least it’s an institutional acknowledgment of this very problem.
In my opinion, medicine isn’t about competing with others or personal success. It’s about helping people, and the right approach to helping people is a collaborative one. The job market for physicians is far from saturated, and the pay is decent for most doctors. But the current system for medical training doesn’t reinforce collaboration. It fosters academic and professional insecurity. The result is a field flooded with overly competitive people who aren’t in medical school for the right reasons.
As mentioned, I also take issue with the manner in which undergraduate biology is taught. Biology was the field I initially intended to study at MIT, but I soon felt that many courses weren’t about understanding the material—they were about memorization. I wasn’t comprehending ideas, I was storing information. It lacked depth, it lacked insight—so much so that many quantitatively minded students chose to postpone enrollment until their last semester. (Introductory biology is a school-wide requirement at MIT.)
This wasn’t the biology I knew and loved. Sure, higher level coursework started to delve deeper, and provide insights; but as pre-med students, we weren’t really encouraged to take those. Especially challenging courses were to be avoided like the plague—no B grades! The consensus among many pre-med kids was that we wanted it this way: easy, and memorizable. A good majority wanted their As and enough time to buff up their resumes with other things that medical schools consider sexy, such as halfhearted community-service engagements solely meant to impress admissions committees.
I hated it.
Biology and medicine are full of questions. But the way it was taught, even at MIT, didn’t encourage much inquiry at all. Frankly, I was offered a more exciting approach to biology in high school, which is how I became interested in medicine in the first place. For instance, in high school, I learned why DNA is transcribed (and assembled) from its 5′-end to the 3′-end. (It has to do with nucleotides being activated by the phosphate group.) It’s not always possible to understand the reasons behind mechanisms, and some memorization is inevitable, but reducing biology to regurgitated facts deprives it of its beauty.
When I was taught how the genetic code could be deciphered in high school, I was actually given a mock-up of the data that the Nobel-prize winning biochemist Har Gobind Khorana used to figure out that the codons come in triplets! I expected a similarly exploratory approach at MIT, but instead, the first quiz in biochemistry was to memorize the chemical structure of all 20 amino acids. Boring!
At this point, I began to pursue computer science as an alternative major, although I still considered medical school a possibility. Once I learned more about the field, I felt that the academic trajectory of medicine was too restrictive for me. As a doctor, you are forced to follow protocols—a good doctor knows more of them, but doesn’t typically develop them. If you try inventing a method by inappropriately experimenting on a patient, you might provoke litigation (and rightly so). The protocols are coming out of research labs, not practicums. I wasn’t interested in more memorization. I wanted to be an inventor.
I have returned to biology for my PhD at Harvard, hoping to answer the questions that actually excite me, using modern quantitative approaches. In my current research I am using mathematical models to describe biological systems and their evolution.
Maybe, in the distant future, my research will actually have some impact on medicine. Because, I must say, I still have a little void in my heart for not following through on medical school. My grandfather was a doctor who devoted his entire life to working in a rural area, and 30 years after his death people, still speak highly of him and the services he rendered. Missing out on that aspect of medicine, directly improving people’s lives, is my biggest regret. I love the profession, I just loathed the path to it.
Things are improving, however. Biology is becoming more and more quantitative in its approaches to research and innovation, and the future of medical education will become increasingly about critical thinking, rather than rote memorization. Especially with the availability of medical search engines and online libraries (which provide easy access to data), medical-assistant software and increasing reliance on para-clinical technology (MRI, blood tests, sonography, genetic screening), the key role of the “human-in-the loop” (the doctor), will be to provide the analytic insight to patients and their loved ones.
Shifting focus toward inquiry-based curricula means medical schools will be getting more applicants who are genuinely excited about solving problems. If this change in methodology is recognized by medical schools and undergraduate pre-med programs alike, I would say the future of medicine, and clinical research, is a bright one indeed.