I wanted to follow up on some issues that I have blogged about recently.
On February 4, 2011, in my post Why do we put so much import on the MCAT , I wrote about the value of the admissions test for medical school. The Medical College Admissions Test is one of several screening mechanisms used by medical schools to determine who should be allowed to pursue medical training. A recent editorial (1) in the New England Journal of Medicine by Joshua Tompkins (Science Journalist and Medical Student at the USC Keck School of Medicine) discussed the expense of MCAT and Board prep courses. According to Mr. Tompkins, medical students are taken advantage of by a "multi-million-dollar industry in commercial exam-preparation assistance". These (for-profit) companies play on student's fears--fears of failing, of not getting a high enough score to get into their residency of choice, their fear of not matching in any residency. The problem is that there is little to no evidence that these board prep courses actually do anything to affect a student's score on the MCAT or USMLE step 1. A systematic review of commercial test preparation (2) found that "current research lacks control and rigor" and the evidence to support these courses was weak or non-existent. According to Mr. Tompkins, pre-clinical medical students "focus on obscure minutiae and rare conditions" and "spend less time studying the common diseases they will face during clerkships, residency, and practice".
And while we are talking about medical school admissions. In another recent blog, Personality traits that predict success in medical school , I wrote about using personality profiles to chose which students should be in medical school. An article in the July 10, 2011 New York Times by Gardiner Harris, New for Aspiring Doctors, the People Skills Test reports on the use of a specific type of medical interview that is being implemented at Virginia Tech Carilion School of Medicine in Roanoke, VA. The Dean at Virginia Tech Carilion is a family doctor named Dr. Cynda Johnson. She happens to also be a former resident and faculty member from the University of Kansas. Virginia Tech Carilion (and several other schools) are using the multiple mini interview or MMI to screen potential medical students. The test is administered to students as part of their medical school interview and is designed to "assess how well candidates think on their feet and how willing they are to work in teams". According to Dean Johnson, "if people do poorly on the MMI, they will not be offered positions" in the medical school class. The MMI is also a pretty good predictor of performance in the preclinical years of medical school. (3)
Way to go Virginia Tech. This is definitely a step in the right direction.
(1) Tompkins J. Money for Nothing? The Problem of the Board-Exam Coaching Industry. NEJM 2011; 365 (2): 104-105.
(2) McGaghie WC, Downing SM, Kubilius R. What is the impact of commercial test preparation courses on medical examination performance? Teach Learn Med 2004; 16 (2): 202-11.
(3) Eva KW, et al. The ability of the multiple mini-interview to predict preclerkship performance in medical school. Acad Med 2004; 79 (10 Suppl): S40-2.