[cannaceo]

I completed medical school back in 2012. Here's the unfortunate rub with this particular class--organic chemistry is a requisite for medical school and probably shouldn't be. The class is mostly pre-med students and very few chemistry majors. It seems that once upon a time some administrators decided that students should complete 2 years of chemistry and organic chemistry happened to be the most common second year course available.

Physics courses, at least at my alma mater, were separated in to physics for physics majors("honors physics"), physics for engineers, and physics for life sciences. A similar structure would be a great compromise to maintain the quality of education for those continuing on to perform organic synthesis versus those who want to be physicians. I was exposed to exactly zero organic chemistry in medical school or beyond.

[Ekaros]

Maybe there should be an entire pre-med degree. Or at least half of it, fully focused on the subject. Some other countries just straight up admit to med-school and those who don't pass examinations end up doing things like chemistry, and rightfully treated as such students.

[hilbert42]

"Maybe there should be an entire pre-med degree."

I think there's something to that (but also it is applicable to some other professions). Trouble is it would change the complete order of things (having a 'higher' high school as a prep or similar). Unfortunately, it'd never happen as too much is already tied up in keeping in place the artificial dividing line that separates high school and higher education (think economics, whingeing employers, etc., etc.).

[JamesBarney]

I always thought the point of organic chemistry was to be a weed out course for med students.

Most doctors I know don't know jack shit about organic chemistry. They're operating at a level of abstraction much much higher.

[hilbert42]

"Here's the unfortunate rub with this particular class--organic chemistry is a requisite for medical school and probably shouldn't be"

I've not studied medicine but I've some organic chemistry knowledge thus I've come across this bane of contention previously from others. It doesn't take long for organic chemistry to get bogged down in technical details that I reckon wouldn't be needed by most medical professionals. For instance the angle formed between a benzene ring and an amine group after bonding. That's useful info to chemists but to few others.

But where to we draw the line and how do we determine whether it's actually relevant? I'll make an observation on that question at the risk of encroaching upon your profession with an example (please bear with me I'm not a professional pharmacologist).

Let's start with a well-known example: the metabolism of ethanol by the liver. If I put on a chemist's hat then I'd not be expected to know much more than that the liver employs enzymes to partially oxidize ethanol to acetaldehyde thence from there to acetic acid and finally water and carbon dioxide.

However, if I specialized in the area then I'd need to know much more such as the Gibbs free energy for each metabolic stage and calculating that suddenly becomes very complicated, it'd require me to know much more about the liver's physiology and its enzyme processes. If so, then I'd posit the level of knowledge I'd require would be more than would be expected of you if you were, say, a general practitioner.

Viewing it from your side, you'd have to know enough basic organic chemistry to make sense of the various stages the liver goes through to reduce ethanol to H2O and CO2 such as the basics of Gibbs free energy as ethanol's metabolism provides the body with energy thus you'd have to have an overview of how enzymes go about their work—alcohol dehydrogenase/ADH for instance.

This is where drawing lines gets complicated. If we treat an enzyme as a black box that does various things then we can map out an overall picture of how the liver does its job and perhaps that's all the average practitioner needs to know (I'm not familiar with the extent of that requirement). However, if you are required to have a thorough understanding of how enzymes work then a much greater knowledge of organic chemistry would be required. For instance, the chemistry of alcohol dehydrogenase/ADH and it's complicated, so too the final stage of ethanol's elimination wherein acetyl coenzyme A is involved.

From an outsiders' perspective, it doesn't seem reasonable to me that to do their job that those on the first line of medicine would need chemistry to a depth required to understand how acetyl-CoA works at the molecular level. That would seem a waste of time.

On the other hand a basic understanding of organic chemistry seems necessary to have a cognizant overview of the workings of the liver.

Looking in from the outside it's a difficult call. My own doctor usually writes prescriptions in a drug's proprietary name, on occasions he asks if I want the cheaper generic version to which I always answer yes, he's then been been known to ask me for its chemical name having forgotten it (for some unclear reason he seems to assume that I know more chemistry than he does).

Perhaps this is an indicator that many if not most doctors practice drug/pharmacy medicine at a much higher level than that of molecular chemistry—if so then it would seem that having to have detailed knowledge of the subject at this low level is unnecessary.

Apologies if that seemed a little short on in depth. I intended more but omitted some relevant stuff for brevity (there's more to discuss about this topic but there's practical limits to that on HN). Also, as my profession is electronics, my emphasis may seem a little off not having the same familiarity with the issues as you would have.

[senortumnus]

I appreciate your effort in this post. I am a practicing physician and also a person who majored in biochemistry, rather than the more pre-med focused biology/chemistry major offered at my institution. My opinion is that organic chemistry is a great window into the complexity of biologic chemistry that happens to be the foundation of medicine.

Is it necessary for all physicians to peer through this window in order to practice quality medicine? Perhaps not. But does it give us an appreciation, and humility for, the astounding complexity of biologic systems that underpin all clinical interventions? Ideally so. At some point during pre medical training there should be - to be blunt - a filter that separates adaptable and bright students from those who hazily wish to pursue medicine but do not have the capacity to do so at a high level.

There are many career paths for those who can not adapt and learn at the high level which has been traditionally been required to complete medical school. We can, as a society, either lower the standards or maintain that high level of requirement that has been the badge of "MD." My bias of course, having completed 13 years of education after high school, is to recommend that we do not lower the standards of the MD process. The system, as it has evolved to date, has plenty of opportunity for those who desire less rigorous training, for example nurse practitioner and physician assistant tracks. There is still a place in this world for highly trained and motivated individuals who wish to be the best in their field. Signed, a professional who benefited from the strong institutions that create medical doctorates.

[hilbert42]

The position you've put about medicine is essentially as I've come to understand it having viewed it from the outside.

Had I wanted to do medicine I've no doubt that I'd have thought twice about it given the long and tenacious path I'd have had to have taken to get there. My interests were always in basic science and engineering, so I was never in the position of having to make those awkward decisions.

That said, it wasn't a completely black and white process, at one stage I started pharmacy but changed my mind, that may be obvious from my earlier comments.

I've no doubt that filtering is needed to weed out the less motivated but as I've said elsewhere, I've concerns about how it's done. If good people are weeded out because of say their circumstances then society loses the benefit of their input.

My opinion about organic chemistry is that it is a tremendous subject and I have an abiding interest in it. I think this puts me in a good position to appreciate the dilemma medical people face when confronted with the subject. As you know it can get complicated quickly and getting to grips with it can take a lot of work and time—time that many cannot afford to commit.

Thanks for your thoughtful comments.

[cannaceo]

While I agree that we shouldn't lower the standards of the MD process I am not convinced that proficiency at organic chemistry is predictive of physician quality. I'd rather see physicians studying computer science than ochem as tech seems more relevant to the future of medicine. To that extent I'm always willing to entertain reform.

[hilbert42]

"I am not convinced that proficiency at organic chemistry is predictive of physician quality"

Reckon that's true from the very small sample of my own doctors. It would be nice if we had anecdotal info from MDs who reckon it was actually useful and the reason for why it was.

[cannaceo]

I appreciate your thoughtful response. Some of the concepts you mentioned, such as Gibbs free energy, are covered in intro physics, intro biology, and biochemistry courses that are also required as a physician. I believe one biochemistry class as an undergrad and one year of biochemistry instruction in the first 2 years of medical school.

A simplified organic chemistry course could cover the theory of SN1/SN2 attacks, orbitals, some ochem principles, some medical-focused examples of organic chemistry, and some basic mechanisms. It would not require students to creatively solve synthesis questions on exams or memorize long lists of reactions. To that extent maybe even the first of the two part classes is enough.

I never heard of anyone talk about organic chemistry as anything other than a filter class for pre-meds. It's a bit of academic hazing to wash out weaker pre-meds from the undergrad program. Maybe because it effects the university's match rate. Students care about their undergrad's medical school match statistics when they apply. From what I remember hazing does wash out the weaker students who don't have as high of general intelligence or work ethic.

[Siddarth1977]

My school had weed out classes in my program, but it had nothing to do with graduate admissions or competitive rankings.

The point was that it's better to have a student struggle and make adjustments earlier rather than later in their education. Regardless if that adjustment is "spend more time studying" or "change from STEM to something easier", it's better for it to happen in a students first year than fourth year in college.

The system seemed to work well to me. Lots of smart kids who didn't have to work very hard in high school learned early that they were going to have to work harder in college. Other kids realized they were better changing majors. Everyone who was still in the program their junior year had the confidence that they could graduate.

[hilbert42]

"Lots of smart kids who didn't have to work very hard in high school learned early that they were going to have to work harder in college."

Some don't learn early either. I was smart enough to coast along for quite a while doing little and then I suddenly had to apply myself (it was a bit of a shock). I had to relearn how to apply myself and it was harder than I anticipated.

Of course, this never applied to truly brilliant kids (they're the ones I envy). It also doesn't help when one's parents kept pointing to a couple of brothers who lived several blocks away from my home and saying to the effect 'why can't you stop mucking around and just apply yourself like them'. (They were in different classes to me and a year's difference separated them. Trouble was my mother and theirs used to associate with each other (mother's club and all that stuff), so such comparisons were easy.)

It turned out later that it wasn't that they just had normal brains but with lost of application to study—but more. Some years later (perhaps a decade or so) I opened the pages of Scientific American and started reading a fascinating and informative article, it was then that I turned to the author's name only to realize that I knew that 'bastard'. Also a check of the references showed that he had a string of publications about the subject in other advanced publications.

As they say, that's life.

[cannaceo]

My experience in medical school is that your success is based on your ability to memorize large amounts of information that is of low conceptual difficulty in short periods of time. This isn't a trait that is selected for in passing ochem. Furthermore, ochem is the last time in your undergrad or medical school training where you'll be faced with that level of conceptual rigor.

You could just as easily ask all the undergrads to train for a marathon and see who has the discipline to follow through. It would probably be more relevant because at least its health-related.

I think overall we want our doctors to have high general intelligence so we'll continue to demand o-chem. We all have our biases against the kids who couldn't pass o-chem.

[hilbert42]

"We all have our biases against the kids who couldn't pass o-chem."

Do you think that really true? I know some people who struggled with it who took it (or had to take it) as a major. Others, found it easy because they were good at remembering many details, yet others loved its systematic order.

I love the subject but the amount of detail drives me batty at times (one only has to thumb through a copy of Merck to be overwhelmed by the number of processes, etc.)—and I don't have a photographic memory.

However, I don't see that as a major issue in the long run, for if one is heavily involved with some of its specialized threads/areas then it all makes sense at that level (well sort of for much—duh, some—of the time).

Unlike physics where the rules seem clearer and more straightforward, the detail in o-chem throws people (especially those who don't have a good memory for detail). From my experience, this can become an acute problem around exam time when other subjects are competing for attention. Some people do much better in that situation than others, it doesn't mean that they're not good students, or haven't tried hard enough—or that they even dislike the subject.

It seems to me it's the nature of the beast that is actually the real culprit. Perhaps that ought to be taken into account when teaching the subject (for instance, we could offset o-chem exams from others by scheduling them to be held at a different time of year).

Just a thought.

[hilbert42]

"It's a bit of academic hazing to wash out weaker pre-meds from the undergrad program"

In undergrad chemistry my lab partner was a med student whereas I was doing science and engineering. In essence, there were unavoidable common core threads for everyone.

I'm not saying that's good or bad but it was problem for my co chem student not because he was doing poorly but because he was overloaded (his workload was definitely much heavier than mine).

His experience is the reason why I'm not in favor of that approach because it also filters out good students who do badly for other reasons. For example, some students have family commitments and don't have as much time available for study. Others have less time because they have to travel long distances to lectures.

Take my situation, for a part of my studies I used to travel the better part of 200 miles round trip by train and bus each day. I'd leave home when it was dark and also arrive home when dark—that was nearly 6 hours traveling per day.

Making up time studying on the train wasn't an option as I'd just fall asleep. If I'd been doing medicine and that weeding out process adopted then I'd not have stood a chance.

Edit: at a different period when I eventually managed to get closer to uni my flatmate was also a med student and he too always had a much heavier workload than I did.

If I'd been a med student under those conditions, I reckon I'd have wanted to ditch organic chemistry if given half a chance.