Science & Research

PLME students reach similar outcomes as peers

Study finds PLME, traditional students see comparable residency placements, test scores

By
Contributing Writer
Tuesday, October 13, 2015

University researchers recently led a study comparing the success of students in the eight-year Program in Liberal Medical Education with the performance of students admitted to the Alpert Medical School through the traditional route. The study, published online in the journal Academic Medicine Sept. 25, looked at the test scores and residency placements of students who graduated from the Med School over the last five years.

The study revealed only slight differences in the achievements of PLME students and those who were accepted traditionally. These differences had statistical significance because of the large sample size — 295 PLME students and 215 students admitted conventionally — but “the differences between the two groups were not meaningful in any way,” said Paul George, associate professor of family medicine and medical science and lead author of the study.

The study found the relationship between undergraduate curriculum and success in medical school to be very weak, even within the PLME program. The authors hypothesized that a larger number of undergraduate premedical science courses would be correlated with greater success in medical school and in residency placement, but the data provided little support for this idea. The number of premedical science courses taken at the undergraduate level by PLME students had a minimal effect on their medical school performances, according to the study.

Medical students’ success was measured by competitiveness of residency placement as well as standardized test scores. Only minor differences were noted between the success of PLME and non-PLME students in residency placement, according to the study. Students were placed into primary care and non-primary care residencies at the same rate, George said.

“We had to use rather arbitrary and concocted metrics to be able to compare residency placements,” said Philip Gruppuso, professor of pediatrics and medical science and research professor of molecular biology, cell biology and biochemistry and a coauthor of the study.

The nature of medical work presents a challenge in measuring success, as medical careers have such variation. “It would be nice to look at graduates 20 years out and see what they’re doing,” George said, noting his interest in the relative proportions of students who become researchers, clinical leaders and doctors in health professional shortage areas.

The lack of difference in performance of PLME and non-PLME students calls into question the importance of undergraduate premedical requirements. PLME students have less stringent premedical requirements and are not required to take the Medical College Admission Test.

“There’s really no difference at the end of the day in how students perform in med school, whether they go through PLME or whether they go through a more traditional route,” George said. “I wonder if time would be better spent preparing students to be more holistic in their undergraduate training so they understand people from a biologic standpoint and a non-biologic standpoint.”

Julianne Ip, associate dean of medicine and a coauthor of the study, went through the University’s seven-year medical program before an eighth year was added. “Physicians practice in the real world and need a broad-based education which includes things like history, political science, ethics and public health,” she said. “When you’re interacting with standardized patients it helps you see a more holistic person.”

The movement to revamp standards for premedical education has been growing for many years, Gruppuso said. At Brown, faculty have made efforts to redefine the University’s standards for undergraduate premedical education. “I’ve been trying for many, many, many years to create a more integrated premedical curriculum that really uses biology as a base,” Ip said.

But the process of developing a new curriculum is expensive and time-consuming, Ip said. To be effective, a school cannot make changes on its own — since undergraduates here go on to attend medical schools across the country, those institutions would have to be open to alternative premedical educations as well, she said. The University’s current system successfully sends students to prestigious schools. “Why change what works?” Ip said.

George said the University should not necessarily grow or shrink the PLME program. “The PLMEs inject a really nice mix of different interests and different approaches to medical school and patient care,” said George. “But we also get a really nice cohort of students who come in through the standard program.”

“I wish they did it in more schools across the country,” Ip said.

But combined degree programs like PLME may not be suited to  all students. “There are lots of people out there who would benefit enormously from marching through a very rigorous and traditional educational process,” said David Muller, dean for medical education at the Icahn School of Medicine at Mount Sinai. Muller said the methodology of the study was fair, adding that there is not enough reason for the the University to alter its requirements.

More variety is needed in premedical education, Muller said. “The more diverse opportunities there are to enter health care, the better off we are in medical education and the better off students are.”

The FlexMed program at Mount Sinai offers another alternative route to medical school. It allows sophomores from any major to apply to the Icahn School of Medicine after taking only two semester-long premedical courses. If accepted, students are still required to take additional premedical courses, complete a thesis and maintain a 3.5 grade point average, but they are not required to take the MCAT.

“It makes intuitive sense that because people are so different, there should be tailored ways of getting through the premed experience and into medical school,” Muller said.

As an institution that prides itself on the freedom given to its students, Brown is positioned to question and even redefine the traditional courses required for all premedical students, Grupusso said. “Medical schools should get much more creative and inventive around issues relating to premedical education.”

  • Dirty Little Secret

    The nurses can still tell who’s a PLEME and who isn’t, though.

    • secrets

      I’m a traditional med student… how can they tell? 🙂

      • Not OP

        Tbh the only difference I can see is who looks younger. I have a hard time telling a traditional who went straight through from a PLME.

  • equality4all

    Be careful or else you might give the proletariats ideas!

  • Leep

    I’m a non-science concentrator, pre-med student. Therefore, I was hoping to see that students with a less comprehensive science background perform comparably in medical school. While this article suggests that is the case, the original paper tells a slightly different story:

    http://journals.lww.com/academicmedicine/Abstract/publishahead/The_Association_Between_Premedical_Curricular_and.98682.aspx

    It’s clear that PLME students don’t garner as many honors grades and are less likely to be inducted into Alpha Omega Alpha. Yes, these correlations are weak, but the statement that “the differences between the two groups were not meaningful in any way,” is simply false.

    • Also upvoting your own comment

      The article acknowledges the difference, though it could be more clear. Dr. George offers his interpretation, which is that this is not a meaningful difference.

      On the other hand, both groups still perform successfully and even comparably on matching into a competitive discipline. And look at Figure 3, probably the most applicable to you. You’ll do fine.

    • Premed ’14

      Let’s go over some of the data in the paper:

      Average year 1-2 examinations score
      TPM (traditional premedical route) higher than PLME; p<.001

      USMLE Step 1 score
      TPM (230?) higher than PLME (224); p<.001

      Average shelf examinations score
      TPM higher than PLME; p<.001

      USMLE Step 2 CK score
      TPM higher than PLME; p<.001

      These data are all highly significant showing that students who entered traditionally scored higher on these exams compared to PLME students.

      Some other data:

      25.6% of TPM students were inducted into AOA, while only 10.4% of PLME students were (p<.001). I would say that this is perhaps the most illustrative difference between PLME and traditional students.

      No differences were found in induction into the Gold Humanism Honor Society, enrolling in a scholarly concentration, or matching in a competitive discipline. Note: there were no categories in the paper in which PLMEs scored higher than TPMs; however, they were more racially and ethnically diverse.

      I would say that the metrics for residency placement are debatable because there is no agreed-upon method to rank different institutions and different residencies. The authors claim that the association between exam scores and residency placement is weak (they found a small [p<.05] association), though common wisdom suggests otherwise. I believe their conclusions may have resulted from the somewhat arbitrary methods of measuring competitive residency placement.

      I also question the authors' hypothesis that taking more undergraduate science courses is a significant factor for medical school performance. Instead, I would propose that the process of studying for the MCAT, preparing and applying for schools, as well as the study methods and work ethic learned through taking traditional premed classes and going through the aforementioned steps are much more important.

      I have to say that I am extremely disappointed in the quality of this article by the BDH. Anyone with the most rudimentary understanding of statistics, and the most basic of literature-reading skills would see that the data show there are very real differences in performance during medical school between PLME and TPM students.