[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.

[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.