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    Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century after the Flexner Report

    Questioning the Premedical Paradigm: Enhancing Diversity in the Medical Profession a Century after the Flexner Report

    by Donald A. Barr


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      ISBN-13: 9780801898402
    • Publisher: Johns Hopkins University Press
    • Publication date: 04/05/2010
    • Sold by: Barnes & Noble
    • Format: eBook
    • Pages: 240
    • File size: 3 MB
    • Age Range: 18 Years

    Donald A. Barr, M.D., Ph.D., is an associate professor at Stanford University in the Departments of Pediatrics and Sociology. He is the author of Introduction to U.S. Health Policy, second edition, and Health Disparities in the United States, both also published by Johns Hopkins.


    Donald A. Barr, MD, PhD, is a professor of pediatrics and education at Stanford University. He is the author of Introduction to U.S. Health Policy, third edition, also published by Johns Hopkins.

    Table of Contents

    Preface
    Introduction
    1. Who Drops Out of Premed, and Why?
    2. The Historical Origins of Premedical Education in the United States, 1873– 1905
    3. A National Standard for Premedical Education
    4. Premedical Education and the Prediction of Professional Performance
    5. Noncognitive Factors That Predict Professional Performance
    6. Efforts to Increase the Diversity of the Medical Profession
    7. Nontraditional Programs of Medical Education and Their Success in Training Qualified Physicians
    8. Reassessing the Premedical Paradigm
    9. Another Way to Structure Premedical Education
    Notes
    Index

    What People are Saying About This

    Jordan J. Cohen

    "Abraham Flexner’s 1910 report on the state of early twentieth century medical education elicited a host of transformational changes in U.S. medical schools, most of which remain as salient today as they were 100 years ago. But not all! As this provocative and timely volume documents, the science and math prerequisites for medical school admission triggered by Flexner’s report have long since outlived their salience. What’s worse, they are serving to dissuade countless students with precisely the backgrounds, temperament and commitment we seek in our physicians from pursuing their dream. Barr supports his thesis with compelling data and provides a blueprint for how the premedical knowledge that is truly required for the study of medicine today can be integrated and imparted more efficiently and less punitively. Medical educators, pre-medical advisors and all those responsible for crafting undergraduate curricula for aspiring doctors are urged to read this book and heed its post-Flexnerian message."

    From the Publisher

    Abraham Flexner’s 1910 report on the state of early twentieth century medical education elicited a host of transformational changes in U.S. medical schools, most of which remain as salient today as they were 100 years ago. But not all! As this provocative and timely volume documents, the science and math prerequisites for medical school admission triggered by Flexner’s report have long since outlived their salience. What’s worse, they are serving to dissuade countless students with precisely the backgrounds, temperament and commitment we seek in our physicians from pursuing their dream. Barr supports his thesis with compelling data and provides a blueprint for how the premedical knowledge that is truly required for the study of medicine today can be integrated and imparted more efficiently and less punitively. Medical educators, pre-medical advisors and all those responsible for crafting undergraduate curricula for aspiring doctors are urged to read this book and heed its post-Flexnerian message.
    —Jordan J. Cohen, M.D., George Washington University and President Emeritus, Association of American Medical Colleges

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    This book raises fundamental questions about the propriety of continuing to use a premedical curriculum developed more than a century ago to select students for training as future physicians for the twenty-first century. In it, Dr. Donald A. Barr examines the historical origins, evolution, and current state of premedical education in the United States.

    One hundred years ago, Abraham Flexner's report on Medical Education in the United States and Canada helped establish the modern paradigm of premedical and medical education. Barr’s research finds the system of premedical education that evolved to be a poor predictor of subsequent clinical competency and professional excellence, while simultaneously discouraging many students from underrepresented minority groups or economically disadvantaged backgrounds from pursuing a career as a physician. Analyzing more than fifty years of research, Barr shows that many of the best prospects are not being admitted to medical schools, with long-term adverse consequences for the U.S. medical profession.

    The root of the problem, Barr argues, is the premedical curriculum—which overemphasizes biology, chemistry, and physics by teaching them as separate, discrete subjects. In proposing a fundamental restructuring of premedical education, Barr makes the case for parallel tracks of undergraduate science education: one that would largely retain the current system; and a second that would integrate the life sciences in a problem-based, collaborative learning pedagogy. Barr argues that the new, integrated curriculum will encourage greater educational and social diversity among premedical candidates without weakening the quality of the education. He includes an evaluative research framework to judge the outcome of such a restructured system.

    This historical and cultural analysis of premedical education in the United States is the crucial first step in questioning the appropriateness of continuing a hundred-year-old, empirically dubious pedagogical model for the twenty-first century.

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    From the Publisher
    Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion and framing it to allow the current model of premedical education to be rethought in a way that will conform to the needs of the profession and to the needs of society as a whole.
    —Dennis Rosen, MD, JAMA

    Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion.
    —John L. Zeller, JAMA

    Barr’s is a multifaceted book, so a variety of disciplines will find various chapters useful to their goals. Teachers of education policy will find the sections on educational disparities and pedagogical innovation of great interest; while medical historians and medical humanities programs will enjoy the chapters on the history of and research on premedical education. Clinical Research training programs will find the last chapter useful as a case study in protocol articulation.
    Journal of the History of Medicine and Allied Medicine
    JAMA - John L. Zeller
    "Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion."

    JAMA - Dennis Rosen
    "Barr is to be commended not only for writing such a readable and thought-provoking book but also for bringing this important issue back to the center of discussion and framing it to allow the current model of premedical education to be rethought in a way that will conform to the needs of the profession and to the needs of society as a whole."

    Journal of the History of Medicine and Allied Medicine
    "Barr’s is a multifaceted book, so a variety of disciplines will find various chapters useful to their goals. Teachers of education policy will find the sections on educational disparities and pedagogical innovation of great interest; while medical historians and medical humanities programs will enjoy the chapters on the history of and research on premedical education. Clinical Research training programs will find the last chapter useful as a case study in protocol articulation."

    Doody's Review Service
    Reviewer: Benita D Wolff, M.Ed.(University of Iowa Carver College of Medicine)
    Description: This book challenges the effectiveness and necessity of the current premedicine curriculum. At issue is the "weed out" impact of the current curriculum on students, especially students from groups underrepresented in medicine.
    Purpose: It examines the results of a five-year study of Stanford and University of California-Berkeley students designed to explore the impact of key premedicine courses (i.e. chemistry, physics, biology) on student persistence to enter medical school. The author also provides a history of how the existing premedicine curriculum was established and provides recommendations for curricular changes that could increase the number of underrepresented individuals who enter the medical profession. The author articulates thought-provoking ideas at a time when educators, administrators, and policy makers nationwide are working to fix the leaking premedicine pipeline for minority individuals and individuals from groups historically underrepresented in medicine.
    Audience: This book will be useful for curriculum experts, diversity leaders, premedical advisors, medical school administrators, policy makers and others responsible for preparing students for success in medical school.
    Features: Readers will gain an understanding of the structure and history of the current premedicine curriculum from this book. The author uses the results of a five-year study to explore problems with the current curriculum, particularly for underrepresented minority students. The author challenges readers to reconsider the current process for preparing students for medical school and offers several examples of nontraditional premedicine preparation programs that have proven successful. The book concludes with recommendations for renewing the current premedicine curriculum.
    Assessment: This book will inform my work related to increasing the pipeline of premedicine students, especially minority students and those from other underrepresented groups.

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