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Organic Chem or Nutrition as a Pre-Med Requirement?

James E. Dalen, MD, AJM Associate Editor

James E. Dalen, MD, AJM Associate Editor

Success in an undergraduate course in organic chemistry is one of the master keys needed to unlock the door to medical school.

Organic chemistry became a requirement for admission to allopathic medical schools in 1930.1 In 2015 it continues to be required by 84% of allopathic medical schools and is recommended by an additional 11%.2 It is required for admission to all 34 osteopathic medical schools3 and for admission to the majority of accredited physician assistant training programs.4

But is performance in organic chemistry the best way to determine which of the many applicants for medical school would be the best physicians?

Many have questioned the relevance of organic chemistry to the practice of medicine.1567

It is widely acknowledged that organic chemistry is used to “weed out” applicants to medical school.8910 Is there evidence that failure to excel in an undergraduate course in organic chemistry identifies applicants who are not fit to practice medicine?

In a study of students who chose to forgo a medical career due to concerns about scholastic performance, 78% identified organic chemistry as the specific course that caused them to change their career plans.10 Surely there were some potentially excellent physicians among this group who were culled needlessly.

Although organic chemistry traditionally has been cited as a foundational course necessary to tackle biochemistry, this rationale has been called into question, with some advocating for less emphasis on organic chemistry in favor of education that emphasizes the integration of information across disciplines, with a “tighter focus on science that ‘matters’ to medicine.”7

Few topics in medicine are as ripe models for interdisciplinary study, nor as integral to human health, as nutrition. A recent analysis shows that poor diet is the leading risk factor, among the top 17 studied, for premature death and disability in the US.11 A rigorous course in nutrition would bring together contemporary molecular biology, physiology, epidemiology, behavioral sciences, and other important disciplines with which a physician should be familiar.

In contrast to organic chemistry, it is clear that knowledge of nutrition should play a crucial role in the practice of medicine. Diet plays a critical role in the etiology and prevention of cardiovascular disease,12 as well as some types of cancer1213 and many other conditions.

And with our current understanding of the connection between nutrition and health, replacement of organic chemistry as a pre-med requirement with a course in nutrition would be more useful for future physicians … and society?

If nutrition education replaced organic chemistry as a pre-med requirement, there would be an added bonus for pre-med students who ultimately chose a different career path. Wouldn’t an undergraduate course in nutrition be more likely to contribute to their future health than the knowledge gained in organic chemistry?

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– James E. Dalen, MD, MPH, Stephen Devries, MD, Joseph S. Alpert, MD, Walter Willett, MD

This article originally appeared in the October 2015 issue of The American Journal of Medicine.


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