Students are required to choose concentration at end of 1st year

Critics wonder if the new plan puts too much pressure on medical students.
STANFORD, Calif. (AP) -- Dora Castaneda has wanted to become a neuroscientist since her sophomore year of college, when she volunteered as a physical therapist to a 4-year-old autistic boy.
So when Stanford announced last month it would become the first U.S. university to require new medical students to pick "scholarly concentrations" -- similar in spirit to undergraduate majors -- Castaneda didn't hesitate.
The author of an upcoming epilepsy article in the Journal of Neuroscience, she selected the molecular and genetic medicine track, then began another research project on stroke.
"Neurological brain disorders, how they function, why they happen -- this is what I want to do with my career," Castaneda said.
Attracting specialized, career-focused students is one reason Stanford University Medical Center overhauled its curriculum and required students to pick a concentration by the end of their first year. Officials say the policy puts Stanford at the forefront of medical education.
Harvard Medical School is considering a similar requirement, said Malcolm Cox, Harvard's dean for medical education. Many of the nation's top medical schools, including Michigan and Northwestern, are introducing dual-degree programs aimed at providing students with subspecialties long before their hospital residencies.
On the other side
But critics, including some Stanford medical students, say the requirement piles even more pressure on harried first-year students. Others say the specialized approach does little to encourage general practitioners and could exacerbate a growing shortage of American primary care physicians.
School officials argue that eight broad concentrations -- including immunology, women's health, bioinformatics and bioethics -- accommodate family medicine or any niche. Administrators say the extra focus simply provides a channel for students' intellectual passion.
"Students in medical school turn into cookie cutters, all learning the same, huge amount of data, and by the end, the idealists are gone," said Dr. Julie Parsonnet, Stanford's senior associate dean for medical education.
"We're saying, 'We know you're all different from one another and you have individual reasons for going to school.' We want to foster that passion and still produce great doctors."
When asked what they'd want in a retooled program, Stanford students overwhelmingly asked for more time for unique research -- in part to pad their r & eacute;sum & eacute;s and land the specialized residencies seen as a launching pad to lucrative careers.
The average medical student in 2002 graduated with $104,000 in student debt, according to the Association of American Medical Colleges. The salary gap between general practitioners and neurosurgeons or other highly specialized doctors is often several hundred thousand dollars per year.
What's ahead
Educators are monitoring Stanford, and success could inspire programs throughout the country. Proponents say the "Stanford model" reflects the competitive nature of medical students.
Dr. Raymond Curry, executive associate dean for education at Northwestern University's Feinberg School of Medicine, Chicago, called Stanford's experiment provocative and risky.
Physicians in training must learn a staggering array of facts required by the Liaison Committee on Medical Education, North America's accrediting authority for medical schools. It's unclear whether Stanford's program could prove distracting for first-year students.
"The classic metaphor for medical students is that they're trying to drink from a fire hydrant -- there's so much information," Curry said.
"The trick is whether Stanford will manage this tension between medicine as an all-encompassing liberal education endeavor, and the fact that we have to ensure that every student has been introduced to a very broad range of topics we're required to present to them."