Stanford medical major rule says students must pick path early

Critics say asking first-year students to choose a scholarly concentration points them toward specialties too soon.

By Myrle Croasdale, AMNews staff. Dec. 15, 2003.

Steve Ortiz, a first-year medical student at California's Stanford University School of Medicine, is already thinking seriously about a career in organ transplantation. While most med students spend their first year deep in basic science, Ortiz is also working in a transplant surgeon's lab, and he'll be picking a major. Immunology is his first choice, since the immune system's response is crucial to the success of transplants.

"If all goes well, I'm well on my way to getting into a surgical residency when the time comes," Ortiz said.

Stanford is the first U.S. medical school to require that all of its students choose a scholarly concentration by the spring of their first year.

Stanford officials believe the concentrations will allow students to develop an expertise in one particular area within the broad range of subjects required of all doctors in training. Proponents see it as a way for tomorrow's physician leaders to develop analytical and investigative skills.

Critics, however, say the structure asks students to specialize too soon. They say if such a concept spreads -- Harvard is considering it -- the trend away from primary care among medical graduates could be accelerated and the nation's health jeopardized.

Stanford's administrators and faculty, however, aren't making that leap.

"By no means does a scholarly concentration make them a specialist," said Oscar Salvatierra, MD, director of the Pediatric Kidney Transplantation Program at Stanford and chair of a faculty committee helping shape the new curriculum, which Stanford debuted this year.