FRASER SMITH, MATD, ND

Educational standards for physician training programs have risen substantially from what they used to be. For a long time, the normal route to medical school was to obtain a baccalaureate degree prior to medical school. Not wanting to be left behind or perceived as sub-par, naturopathic medicine has kept up with this change. Sometimes students can start a program without a complete undergraduate degree, which is also true in allopathic medicine. But the 4-year degree prior to entry is the rule, not the exception. A few US medical schools have a dual BSc/MD degree.¹ Some Caribbean medical schools also have this option and are more forward about marketing it as a “6-year” training program.²

When we look around the world, we see a different pattern. In many countries, students go from secondary school to a 6-year physician training program.^3,4 This includes a grounding in the biomedical sciences and learning about diagnosis and treatment. Medical school admissions start in high school and appeal to those who have the highest grades.

How is it that those other countries with advanced medical systems can do it this way? And what is the point of a 4-year degree prior to admission to medical school? If we start with this question, we come back to the fact that for much of the 20th century, allopathic medicine sought to identify doctors’ credentials at the postgraduate level, alongside other advanced degrees.

Which Degree is Needed?

While certainly strenuous to an extreme, a medical degree is not the same thing as a research degree. Students who are in PhD programs complete a baccalaureate, then a master’s degree, and then go into a doctoral program where they focus their research and create new knowledge.

Medical degrees, on the other hand, are a kind of “first professional degree.” In some countries – many in the European Union, the degree is referred to as a Baccalaureate of Medicine or Baccalaureate of Surgery. The idea of course, is that this is not a true “graduate” degree. It is a preparatory degree that leads to postgraduate training in a hospital. This might seem to be a very narrow interpretation. This would never fly in North America, where an MD is a highly prestigious credential. The appeal of a 6-year, combined BSc and MD for many is that is that it encompasses some postgraduate level sciences and a full first professional degree.

Do baccalaureate degrees really do all that much for people though? Well, it depends on the degree and how one goes about earning it. For some students, an undergraduate institution is where they go to take advanced courses in a discipline and get to work in a grant-funded research lab. They go very far over 4 years. For others, the 4 years is a time of great intellectual growth. They develop new perspectives. Yet for others, while an important period of their lives, they don’t experience 4 years of intellectual expansion. They languish, mixing up various subjects, they take whatever prerequisite courses are required for medical school or other graduate work they may be interested in.

The widely discussed research by Richard Arum and Josipa Roksa, published in their 2010 book, Academically Adrift, was clearly a negative when it came to outcomes of undergraduate studies.⁵ They looked at ACT scores, transcripts, and interviews of more than 2,300 undergraduates at 24 different institutions. They found that 45% of these students demonstrated no significant improvement in a range of skills – including critical thinking, complex reasoning, and writing – during their first 2 years of college. The validity of the ACT test toward this end has been debated. Arum and Roksa did find that students made more progress after their first 2 years, and this indicates there are potential hazards to moving away from the 4-year preparation for naturopathic medical school.

Transition to Professional School

When students start professional school, they are often taken aback by the workload. Regardless of the demands of their prerequisite work, they still must adapt to the new challenges before them. For some, the medical school experience is overwhelming. What would naturopathic education look like for students in a 6-year program? For some students, transitioning after 60 credit hours might be jarring. They may not have had sufficient time for intellectual maturity or growth in study abilities. They might be easily discouraged by setbacks. The time required to develop sufficient study skills might interfere with their progress in the program and put them far behind in their schoolwork.

With an average acceptance rate of 6.3% for the 100 top-ranked US medical schools, it’s clear that these schools recruit students with certain attributes.⁶ One of these critical attributes is the ability to absorb massive amounts of information within short time frame. These students can catch what is being thrown at them. I don’t believe that this makes these students necessarily smarter than those who cannot compress and store coursework as rapidly. It is, however, a certain skill set.

That doesn’t mean that allopathic medicine doesn’t attract a lot of very intelligent people with broad interests and good reasoning skills, of course it does. But this system selects a group of students who are already proven to be able to assimilate a lot of material in very little time. Naturopathic students have this ability, and they have other attributes. They can simultaneously learn multiple disciplines: diagnosis, botanical medicine, clinical nutrition, homeopathy, physical medicine, and more. Also, the “right-brain” tendencies of many naturopathic students means that they are looking for connections between events. They are often doing more than just soaking up content, they want to integrate the information into a model of health and disease that makes sense to them.

Benefits of a 6- or 7-Year Program

What would be gained from a switch to a 3 + 4 or a 2 + 4 model for naturopathic education? For one thing, it may reduce the debt load for students. Every year spent living away from home and not working full time means more debt or depletion of savings. A change might make a naturopathic education more attractive to some students. Over the years, they might have been thinking of careers in nursing, occupational therapy, or as a physician assistant. Giving these students a clear pathway to enter naturopathic medical school could do a lot for our colleges’ growth. Given that inflation, a changing and more mobile workforce, and competition for bright minds are all real factors right now, a more direct entry could speak to the potential naturopathic students of the 2020s.

Next Steps

If a 2-year or 3-year entry model was ever done, it would mean rethinking curriculum design. Naturopathic medicine has made incredible strides in its educational system over the past 50 years. Requiring at least 3 years of undergraduate studies, and preferably a baccalaureate, makes sense for a profession that has had to fight for every inch of licensure. Legislators always ask, “What are your educational standards?” And as we all know, naturopathic medical school is very difficult. It teaches a broader, and in some ways more complex, scope than many MD programs, and it does so at an equally high or higher level of rigor. Anything that takes naturopathic medicine education away from current medical school norms could make new licensing efforts difficult. This is certainly an issue worth considering when discussing changes to the naturopathic medical school curriculum.

If a new approach were to be made, any proposed need for a forceful or “weed out” experience in that first semester could become a fiasco. An invitational approach, a developmental approach that demands much but supports students to develop learning strategies and study skills, is what is most likely to succeed. With increased competition and broad options for students across multiple disciplines, we can be certain that the rest of higher education, and medical education, will not standstill. Thus, naturopathic medicine should exercise its right to think creatively and act innovatively in its educational enterprises.

[Refs]

Combined BSMD Programs. Directbsmd.com. Available at: https://www.directmedprograms.com/6-year-bsmd-programs.html. Accessed March 27, 2022.

Six-Year MD Pathway. St. George’s University. Available at: https://www.sgu.edu/academic-programs/school-of-medicine/md/6-year-md-pathway/. Accessed March 27th, 2022.

Six Year Medical Program. Hope Medical Institute. Available at: https://www.hopemedicalinstitute.org/academics/programs/6-year-md/. Accessed March 27, 2022.

Medical School for High School Students. Medapplications.com. Available at: https://medapplications.com/direct-entry-md-programs/. Accessed March 27, 2022.

Arum R, Josipa Roksa. Academically Adrift: Limited Learning on College Campuses. Chicago, IL: University Of Chicago Press; 2011.

MCAT, GPA, and Medical School Acceptance Rates: The Med School Selectivity Index. Accepted. Available at: https://www.accepted.com/medical/med-selectivity-index. Accessed March 27, 2022.