Retuning the Premedical Compass: A Systematic Review of Premedical Course Requirements in American Programs Worldwide (Preprint)

<sec> <title>BACKGROUND</title> Premedical education provides the academic foundation for entry into medical school, yet requirements differ widely across institutions. Recent MCAT reforms and growing calls for more comprehensive and interdisciplinary premedical training have triggered curricular changes fragmented throughout the literature. The objective of this systematic review is to assess how premedical course requirements in American programs worldwide have changed since year 2000 while also evaluating their motives and outcomes. </sec> <sec> <title>OBJECTIVE</title> No comprehensive systematic review on how the premedical curriculum has evolved with time exists. Thus, this systematic review, encompassing all these reforms and changes, will be a unified framework that may help both institutions and students be aware of the premedical course requirements on a wider scale and determine which reforms are most effective. </sec> <sec> <title>METHODS</title> We systematically searched four databases (MEDLINE, Embase, ERIC, and Education Research Complete) 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 post-medical curricula, or requirements beyond courses were excluded. Two reviewers independently screened articles at title abstract and full text levels, with conflicts resolved by consensus among all team members. Data extraction was also performed in duplicate. The Mixed Methods Appraisal Tool (MMAT) was used to assess risk of bias. Because of its heterogeneity, the data was synthesized narratively. The protocol was registered on the Open Science Framework. </sec> <sec> <title>RESULTS</title> We included 70 articles which ranged between mixed-methods, quantitative, qualitative, and descriptive (not studies) designs. Three drivers of reform were identified: conforming to MCAT revisions, educating and forming well-prepared aspiring physicians, and transitioning to competency-based education. Thirty-six studies highlighted adding courses (anatomy, psychology, sociology, humanities), twenty-five described revising existing courses (mainly science courses), five discussed course deletions (mainly organic chemistry and calculus), and ten proposed new curricula (programs or majors). Outcomes prevalently showed improved preparedness for medical school, and positive student feedback and academic performance, though some results were mixed. </sec> <sec> <title>CONCLUSIONS</title> Well established reforms to the premedical curriculum can strengthen student preparedness, satisfaction, and motivation. However, effects on academic outcomes remain inconsistent. 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. </sec> <sec> <title>CLINICALTRIAL</title> Open Science Framework https://doi.org/10.17605/OSF.IO/TPSF2 </sec>