When medical students are overwhelmed, frustrated, and questioning their ability to keep up, they come to one of us, C.A., a learning specialist. The first weeks of medical school are brutal — students struggling not just with their coursework but with the sheer adjustment to the relentless pace of their new reality.
Emily (not her real name) was one of those students. Coming from an engineering background, she had never encountered microbiology beyond the minimal exposure provided by the MCAT. Within days of starting medical school, she was drowning. Concepts like bacterial structures, viral replication, and antimicrobial mechanisms weren’t just new — they were foreign, making it nearly impossible for her to grasp the foundations of infection-related pathology and treatment.
And she’s not alone.
Medical schools require biology, chemistry, physics, and sometimes advanced biochemistry or genetics. But one critical subject is missing from that list: microbiology. Without it, students like Emily enter medical school at a disadvantage, scrambling to understand pathogens, antibiotics, and infectious diseases while trying to keep pace with a curriculum that assumes they already have this knowledge. Medical schools must make microbiology a prerequisite.
Understanding the pathogens behind infectious diseases is fundamental to medicine. A future physician must know bacteria, viruses, fungi, and parasites — their structures, replication processes, and virulence factors — to accurately diagnose, treat, and manage infections.
Consider bacterial cell walls. Knowing their composition determines which antibiotics will work and why some bacteria develop resistance. Without this knowledge, prescribing antibiotics becomes guesswork — a dangerous game in an era of rising antimicrobial resistance.
It’s easy to assume microbiology matters only for infectious disease specialists, but that couldn’t be further from the truth. Every field of medicine — from surgery to oncology to cardiology — relies on microbiological knowledge.
Surgeons must understand microbial flora to prevent postoperative infections. Oncologists must account for a patient’s microbiota when administering monoclonal antibody treatments. Cardiologists managing endocarditis rely on microbiological principles to tailor treatment strategies. Microbiology isn’t a niche topic — it’s foundational.
Despite its importance, medical schools often dedicate only a few weeks to microbiology, leaving students underprepared for clinical applications. This gap becomes glaringly obvious after the second year of medical school. That’s when students reach their Step 1 board exams, where microbiology makes up 10-20% of the content. Suddenly, they’re expected to master a subject they barely covered — often resorting to rote memorization instead of deep understanding. Why are we forcing students to learn critical knowledge in a panic instead of giving them the foundation they need from the start?
This is not just about making sure students who are clearly talented can graduate from medical school. It’s also about making sure that they are able to practice effectively once they do.
The rise of antimicrobial resistance (AMR) is one of the greatest challenges facing modern medicine. As pathogens evolve, physicians must stay ahead, understanding the mechanisms of resistance — enzyme production, drug target modification, efflux pumps, and more. Yet current medical curricula barely scratch the surface of these topics. Ensuring a strong microbiological foundation must begin before students even set foot in medical school.
Covid-19 made one thing clear: Understanding microbiology is non-negotiable. The rapid emergence of new pathogens, the complexities of viral replication, and the global nature of infectious diseases demand that physicians enter the field prepared. Yet, with limited microbiology training, are we truly equipping them to handle the next pandemic?
Every year, students like Emily struggle — not because they lack intelligence or dedication, but because they weren’t given the foundational knowledge they needed before medical school. When Emily started preparing for Step 1, she was shocked at how much microbiology dominated the exam. If she had taken microbiology before medical school, her coursework and board preparation would have been far less stressful and far more effective.
Medical schools have the power to fix this. By making microbiology a prerequisite, they can ensure that incoming students possess the critical knowledge necessary to succeed from day one.
This change isn’t just about making medical school easier — it’s about making future doctors better. A stronger foundation in microbiology means better clinical decision-making, improved patient care, and a more prepared medical workforce.
Medical education must evolve. And the first step? Start small — start with microbiology.
C.A. Tolchinsky, Ed.D., is a medical education learning specialist at Nova Southeastern University College of Allopathic Medicine. Bryn Tolchinsky, M.S., is a senior scientist at Eli Lilly.
