Earlier this year, the Association of American Medical Colleges announced some substantial changes to the Medical College Admission Test, which is widely known as the MCAT.
Although the MCAT is used as a key consideration for admission to most U.S. medical schools, many have questioned whether the test, especially the writing sample, is biased against applicants with disadvantaged backgrounds. Additionally, it is not clear whether the MCAT helps select applicants who will be the best physicians because there is little focus on the non-science factors that are important to being a good physician.
For the past three years, a committee has considered whether the current version of the MCAT provided the best opportunity to evaluate potential medical school applicants. The committee has now proposed changes to the MCAT that could help better identify applicants who have a greater understanding of behavioral and social factors that contribute to health problems. The committee has acknowledged that in addition to a strong base in science, you have to understand the complex relationships between behavior, socioeconomic status, and health. The more a physician realizes that social factors impact health, the more it could help him or her understand health consequences.
Of the current MCAT’s four sections, two would remain strictly science, assessing how well the test taker solves problems about molecular, cellular properties as well as the physical, chemical, and biochemical properties of living systems. The planned changes, which will begin with the MCAT in 2015, include
– Revise the current verbal section to assess the way test takers reason through passages. Test takers will have to read passages pertaining to health and could include cultural literacy, ethics, philosophy and population health. The current writing section would be eliminated, under the new proposals.
– Add a new test section on the behavioral and social sciences concepts that lay the foundation for medical students’ learning about the human and social issues of medicine. The test would cover content covered in intro to sociology and psychology classes, which many students already take as requirements at their schools. This portion would also be multiple-choice and test for competency in understanding ideas, such as behavioral changes, environmental factors on health, cultural differences and inequities, and how demographics or cultural socio-economic differences influence resources and health.
The revised MCAT is expected to increase the test time by more than an hour to six and a half hours.
Although I applaud the Association of American Medical Colleges for recognizing the importance of the social determinants of health in medical education, I’m not sure that testing the “Psychological, Social, and Biological Foundations of Behavior” as part of the MCAT is the best method for identifying the most prepared students.
The revised test may actually obstruct the ability to identify prospective medical school applicants who have broader knowledge about people and culture. One of the concerns about the medical school admissions process is the emphasis on the MCAT score. The medical school application and the admissions interview offer a number of opportunities to determine how prepared and knowledgeable an applicant is related to the social determinants of health.
If future applicants have to prepare for a longer MCAT, take more courses prior to medical school, and possibly pay for a more expensive test, this may actually deter some very qualified applicants.
Don’t get me wrong; I’m delighted to learn that the writing sample will no longer be a part of the MCAT. It’s been 20 years since I took the MCAT but the essay still haunts me. Perhaps a better approach would be to integrate more social determinants of health, cultural competency and population health in the medical school education and training programs.
