Tuesday, August 10, 2010

Are humanities majors more compassionate than science majors?

A recent New York Times article perpetuates the notion that people who major in the humanities are more humanistic than those who major in science. The article's focus is the Humanities and Medicine Program at the Mount Sinai Medical School in New York, which every year admits up to 35 students who have skipped the three usual requirements: organic chemistry, physics and the MCATs.

Not only are the 35 students allowed to skip these requirement, in fact, they are required to go even further. They apply early on in their college careers-- in their sophomore or junior years--and must agree to choose their majors from within the humanities or social sciences. No physics or biology majors need apply, even if they have avoided organic chemistry and the MCATs. And forget computer scientists, engineers, and mathematicians.

Following a recent study comparing Mount Sinai's humanitarians to other medical students, the program is being touted as one that produces equally capable doctors who are more well-rounded, more inquisitive, and better at relating to patients than traditional doctors are. The study, published in the journal of the Association of American Medical Colleges, was conducted by the program’s founder, Dr. Nathan Kase, and by Mount Sinai’s dean for medical education, Dr. David Muller. As the Times reports:

The peer-reviewed study compared outcomes for 85 students in the Humanities and Medicine Program with those of 606 traditionally prepared classmates from the graduating classes of 2004 through 2009, and found that their academic performance in medical school was equivalent.
They scored lower on Step 1 of the Medical Licensing Examination, taken after the second year of medical school, which generally correlates with scientific knowledge. But over all, they ranked about the same in honors grades and in the percentage in the top quarter of the class.

Weighing in on the humanitarian hypothesis, the Times states that:
For decades, the medical profession has debated whether pre-med courses and admission tests produce doctors who know their alkyl halides but lack the sense of mission and interpersonal skills to become well-rounded, caring, inquisitive healers.

The Times then quotes Dr. Kase on the traditional set of requirements:
"...it also diminishes; it makes science into an obstacle rather than something that is an insight into the biology of human disease.”

Doctors who are equally capable, but more empathetic and inquisitive than average. What more could you wish for? But is this really what's going on?

As far as academically capability goes, the article's fine print reveals that the admissions process still uses traditional gambits to ensure bright students with a strong foundation in science. Applicants must maintain a 3.5 grade-point average. If they are admitted, they must take basic biology and chemistry. Before attending Mount Sinai Medical School, they must enroll in its summer boot camp, which provides "abbreviated" organic chemistry and physics courses. And standardized test scores still help determine admissions, namely, high school SAT scores. Actual admissions, the Times reports, "heavily favor elite schools." Students accepted in 2009 had average math and verbal SAT scores of 1444, and G.P.A.s of 3.74.

So it doesn't really surprise me that these students do well as doctors. In fact, I've always questioned the usefulness of the large quantities of detailed knowledge that the MCATs require--given how much doctors later seem to forget. And I've often wondered how often doctors actually apply general principles from physics or inorganic chemistry. It seems to me that overall intelligence, combined with a basic foundation in science, is much more predictive than whether you know your alkyl halides, or your General Relativity, or your VSEPR Theory, much of which, I suspect, few doctors remember, let alone apply, by the time they practice medicine.

What about the idea that Mount Sinai's humanitarians are in fact more sensitive and inquisitive? Here's what the Times reports about actual empirical findings, as opposed to wishful assertions:
The study found that, by some measures, the humanities students made more sensitive doctors: they were more than twice as likely to train as psychiatrists (14 percent compared with 5.6 percent of their classmates) and somewhat more likely — though less so than Dr. Kase had expected — to go into primary care fields, like pediatrics and obstetrics and gynecology (49 percent compared with 39 percent). Conversely, they avoid some fields, like surgical subspecialties and anesthesiology.
But what surprised the authors the most, they said, was that humanities students were significantly more likely than their peers to devote a year to scholarly research (28 percent compared with 14 percent).
The idea that psychiatrists are better at interpersonal relations than specialty surgeons and anesthesiologists does not square with my personal experiences. Some of the nastiest, least inquisitive academics I'm familiar with, lacking the humility and openness to new ideas that comes from exacting standards of truth, are Critical Theorists, not physicists. The idea that humanities majors are more compassionate and broadly inquisitive than science majors is one of the biggest right-brain biases of our time.

As family physician Bertie Bregman writes in the New York Times Letters section:
It is tempting to believe that the study of humanities would naturally produce more humane physicians, as the research done at Mount Sinai School of Medicine seems to conclude. But while the humanities can provide a unique path to insight, that doesn’t necessarily translate into better, more sensitive doctors.

Empathy and compassion in young doctors are as common in chemistry and biology majors as they are in classics majors.
A surprising observation? It shouldn't be.


ChemProf said...

It is definitely stereotypical thinking, but there is also some confusion about what med schools want. Med schools have never cared about student majors. They don't require upper division science coursework at all, although some California schools are starting to require upper division biology, and there have been discussions about dropping physics for at least the last ten years.

Med schools require organic chemistry for two reasons that have nothing to do with whether a student understands a Diels-Alder reaction or not.

1. It cuts down the number of applicants -- think about how many college students were pre-med until they hit organic.

2. It tests whether students can absorb a large amount of unfamiliar information. Every other premed course (General Chemistry, General Biology, and General Physics) is very familiar to a well prepared high school student. In fact, since med schools don't accept AP credit, many pre-med students are just retaking things they did already in high school. Organic is the only course that they are unlikely to have seen, and it requires learning an unfamiliar scientific logic and language very quickly. That's a marker for an ability to do well in med schools, but if they really cared about material, they'd require biochemistry.

At my institution we have a pre-med post-baccalaureate program, where students without science backgrounds complete the pre-med requirements in two years. These students get into med school at very high rates but they definitely are not science students. Our pre-med coordinator came back from a conference with medical school admissions officers, and was shocked at how little they cared about science coursework or research. In fact, a student who had done too much science research was at a disadvantage to students who had lots of "community engagement" that didn't have any science-focus. The basic attitude was "why don't they just get a Ph.D.".

1crosbycat said...

As for being more compassionate with a deeper understanding of human nature, what I have had to learn recently about the worldview of social sciences and philosophy leads me to agree that these drs would be more "humanistic",as in having a secular humanist worldview, but not more humane (which goes with psychiatrists, who I have not found especially congenial or helpful). It just seems like more dumbing down of a typically technical field requiring truly exceptional people - as in let's tweak the system to get more right brain people in med school.

Katharine Beals said...

Fascinating comments!

How interesting to learn that the organic chemistry serves as an intelligence (memory) test, as well as as a screening test. As far as its screening function goes, I wonder if there is pressure to drop this when medical school applications are down (are they currently down)?

ChemProf said...

Yes, you do see this. I think that the discussions about dropping physics for example start up when the applications drop and tend to go away when the numbers come back. Since every med school has to agree to some extent, it is hard to really change the requirements except for special programs.

Even the physics requirement shows that they don't exactly care about science knowledge as much as ability to memorize. Med schools don't require calculus based physics, which is typically much more systematic and which is based on deriving the formulas you need rather than memorizing. They'll take it, but they are perfectly happy with an algebra-based physics course (often called physics for life sciences).