"The goal of Brown's PLME is to graduate doctors, scholars and leaders in medicine who have been exposed to a wide, sensitizing view of the human condition." So reads the educational philosophy of Brown's Program in Liberal Medical Education. On paper, the spirit of the PLME is admirable. Train doctors unfettered by the stresses of the MCAT or resume-building, and surely they will have more time to devote to a liberal education, which in turn will enable more humanistic medicine. Notably missing is a stance on the preparedness of graduates of the PLME, and in practice, even basic competencies are sacrificed in the name of diverse learning. Even then, the compulsory competencies for a PLME undergraduate are so minimal as to be farcical. The result is students who are woefully underprepared for medical school.
Such problems are endemic to the program, and recent reforms have sought, in a measured capacity, to address them. The incoming PLME class of 2015 will no longer be able satisfy the physics requirement with a 650 on the SAT II Physics test or an A- in AP Physics, as their predecessors were. Instead, they need merely a 5 on the AP Physics B or the AP Physics C: Mechanics test. Compare that standard, however, with the MCAT's expectation of competency across the physical disciplines of Newtonian mechanics, electricity and magnetism, optics, acoustics, hydrostatics, electronics and particle physics, and it is clear that we expect far too little of our PLME students.
The societal impact of such under-education is admittedly questionable. Brown's Alpert Medical School is certainly capable of imparting such knowledge to students who need it. Yet PLME students must pay the price. Those who graduate from a conventional pre-medical program either won't need such education or will have sufficient familiarity with the subject material to facilitate deeper study. The consequence is two-pronged: Our PLME students in medical school are underprepared and will be disadvantaged compared to their non-PLME peers, and Alpert's medical education must provide courses to teach what most other medical students already know. The latter scenario results in a decreased quality of medical education and repetition antithetical to the PLME's emphasis on efficient and diverse undergraduate learning. Consider the non-PLME students, studying alongside PLME students, whose education will also suffer, and negative externalities abound.
Discussion of the consequences of the PLME's policies is only half the picture. Numerous and impactful as they may be, analysis focusing on symptoms fails to acknowledge the philosophical discrepancies that cause them. The PLME's commitment to a "wide, sensitizing" education is fundamentally incompatible with the New Curriculum. As Francis Wayland, Brown's fourth president, envisioned, the New Curriculum enables every student to "study what he chose, all that he chose, and nothing but what he chose." The freedom to purposefully exclude undesirable courses from one's education is inherent to that vision. This freedom, however, is antithetical both to what we as a society expect of our doctors and to the PLME's explicitly stated goals.
The PLME and its students suffer from a crisis of legitimacy. While requiring only one semester of organic chemistry pass-fail may help recruitment statistics, it does little else except earn the ire of pre-medical students who must take a full year for a grade. It is no wonder that the Association of American Medical Colleges and the National Resident Matching Program see fit to require undergraduate transcripts for PLME students in medical school applying for residency, a standard not required of medical students that have taken the MCAT.
Granted, PLME students tend to receive excellent residency matches, with several students matched to prestigious schools like Harvard or Yale every year. But this is a testament to the competence of our PLME students and only serves to downplay the failings of the program itself. When PLME students in medical school must expend additional effort to compensate for gaps in undergraduate education, when pre-medical students are deterred from applying to and suffer while at schools like Alpert because of a curriculum that must cater to PLMEs — and, in fact, is to some extent designed by them — and when our PLME students, arguably among the brightest at Brown, are scorned by their peers and additionally tested by national organizations, there is something wrong with the program.
Worryingly, the PLME seems to be headed not toward establishing a baseline of competency, but rather toward eliminating it entirely. As stated by Dean Ip in an email to the PLME community, "the PLME is working on developing a truly integrative curriculum that will eliminate the need for many competency courses." Clear philosophical stances are politically useful, but de facto expectations are insufficient. In keeping with the higher expectations placed upon doctors and the PLME's commitment to liberal education, the PLME should institute some form of distribution requirements to ensure a broad education. PLME students, for their part, would be wise to remember that acceptance into the program is neither a promise of success nor an entitlement to an easy ride.
Young Seol '14 is a chemistry and economics concentrator from Iowa City, Iowa. He can be reached at j_young_seol@brown.edu
