For all the efforts at Harvard, however, its activity lags behind that of some other schocls. Last spring, officials at the Johns Hopkins University School of Medicine said they will eliminate the MCAT as an admissions requirement.
The move received varied appraisals. For example, Foster says he has "mixed feelings" about the change. As to Harvard Med's admissions policy, the dean said he does not forsee any change regarding the MCAT requirement.
Instead, he says, he prefers to recognize reforms in undergraduate curricula--clearing away the "science roadblocks"--as the most significant steps toward better premedical education.
Echoing the recommendations of an influential 1984 report on general medical education by the Association of American Medical Colleges, Foster cites "effective communication skills" and the ability to "study independently" as keys to preparation for medical school.
But even if Harvard and other schools fail to go as far as Johns Hopkins in limiting the MCAT's role, Foster and Hershbach say, the standardized entrance exam will continue to be reevaluated.
Course changes that may humanize the science curricula, focusing on health applications and contexts, may also leave students clueless in front of MCAT exams, or out in the cold in the face of stringent medical school requirements.
In addition, some view the current MCAT as "superficial," testing only the surface of the basic science learned in premedical courses. Critics also point to what they believe is its disproportionate influence. Furthermore, many feel that the MCAT simply cannot measure or predict a student's clinical capabilities--in other words, it says nothing about how good a doctor a student might become.
Most educators agree that the MCAT and medical school admissions policies will not change until undergraduate and graduate teaching are changed. But experts foresee a problem in doing this. They must change what goes on in the classroom in order to reform the criteria by which students are judged, yet they are limited in how they can change curricula by those same criteria.
The key to resolving this dilemma, experts say, lies in the newly developing cooperation and communication between colleges and medical schools.
Joint efforts are already seen as responsible for the Harvard-initiated reforms in premedical education such as the new introductory chemistry curriculum, which has already been greeted with enthusiasm from both premed students and tutors.
But what of the reason for reform in the first place, the emphasis on the basic sciences now widely considered undue?
The pre-med syndrome is not a personality trait, not a row of haggard faces bent over Cabot Library tables that readily double as formica pillows. It is, experts say, a combination of medical school admission policies and pressures, embedded in certain beliefs among the medical community at large.
As Professor Brandt remarks, the "tremendous hope that the answers to social medicine could be worked out at the highest levels of biochemical research" has fostered the emphasis on basic science in pre-medical and medical education. It is precisely this belief that may be changing