Retuning the Premedical Compass in American Programs Worldwide: Scoping Review

Premedical education provides the academic foundation for entry into medical school, yet requirements differ widely across institutions and have shifted substantially over the past 2 decades. Recent Medical College Admission Test reforms and growing calls for more comprehensive and interdisciplinary premedical training have triggered curricular changes fragmented throughout the literature. Such manifestations make it particularly difficult for institutions and students to interpret the direction, rationale, and effectiveness of these changes.

This scoping review aims to map the literature in order to identify key reforms in premedical course requirements and classify these changes into different types: addition of courses, removal of courses, redesign of courses, and the proposition of a new curriculum. This review also evaluates the motives, rationales, and outcomes of these changes for the sake of building a unified foundation for institutions, stakeholders, and students aspiring to delve into medical education.

We systematically searched 4 databases up to July 4, 2025. We included studies focusing on American undergraduate premedical curricula and reporting changes to course or curriculum requirements. Studies discussing non-American programs, medical or postmedical curricula, or requirements beyond courses were excluded. Two reviewers independently screened studies at the title, abstract, and full-text levels, with conflicts resolved by consensus among all team members. Data extraction was also performed in duplicates. The Mixed Methods Appraisal Tool (McGill University) was used to assess the risk of bias. Because of its heterogeneity, the data were synthesized narratively.

We included 70 studies, which ranged across mixed methods, quantitative, qualitative, and descriptive designs. Three recurring drivers of reform emerged: conforming to Medical College Admission Test revisions, educating and forming well-prepared aspiring physicians, and transitioning to competency-based education. From the 70 studies, 36 highlighted adding courses, 25 described revising existing courses, 5 discussed course deletions, and 10 proposed new curricula. Outcomes prevalently showed improved preparedness for medical school, positive student feedback, and enhanced academic performance, though some results were mixed.

To our knowledge, there is no comprehensive review on how the premedical curriculum has evolved over time. Thus, this scoping review, encompassing all these changes, will be a unified framework that may help both institutions and students become aware of the premedical course requirements on a broader scale and determine which reforms are most effective. Since 2000, premedical education has undergone a shift from a narrow science checklist toward a more comprehensive outcomes-oriented preparation, whereby a balanced approach that merges scientific core courses with social sciences and humanities seems to be the most promising for preparing premedical students for medical school and contributing to their professional identity formation. Future work should investigate to what extent these changes to the premedical course requirements have been implemented.