This blog is about medical education in the US and around the world. My interest is in education research and the process of medical education.

The lawyers have asked that I add a disclaimer that makes it clear that these are my personal opinions and do not represent any position of any University that I am affiliated with including the University of Kansas, the KU School of Medicine, Florida International University, or the FIU School of Medicine.

Thursday, June 16, 2011

The new (and improved?) MCAT

Some of you may have heard about the proposed revisions to the Medical College Admissions Test. What do you think about the changes?

The AAMC released the preliminary report from their MR5 advisory committee. This task force was appointed in 2008 with broad representation from medical school deans and administration, basic science and clinical faculty, premed advisors, and included a resident and a student. This group, chaired by Steven Gabbe, MD (Senior VP for Health Sciences THE Ohio State University) was given the task of making recommendations for changes and revisions to the MCAT "that are likely to increase the exam’s value to medical school admissions committees and examinees".(1) The last time that the MCAT was significantly revised was in 1991.

The MR5 Committee got feedback from faculty at medical schools, deans and administrators, resident physicians, and medical students.  In spite of this, some of the changes have gotten significant criticism. They have made fourteen recommendations, including an increased emphasis on Behavioral and Social Sciences Principles and Critical Analysis and Reasoning Skills. (2) 

As I wrote about in a previous blog, Why do we put so much import on the MCAT? , the MCAT has major problems when used as a decision point for medical school.  The MCAT may even be a negative predictor for some important characteristics of physician behavior, such as verbal fluency, breadth of interests, and the ability to communicate. (3) 

So, it seems that changes to the test would be welcomed. I don't know. Honestly, my major problem is not the composition of the test so much as the way that the test is used by medical schools across the country.  The MCAT is the primary determinant for students' admission to medical school, often overshadowing other important factors such as communication skills, altruistic intentions, and a service orientation.

I was surprised by some of the comments on the AAFP's website . These were comments that were posted by readers after an announcement about the MR5 recommendations. Some physicians seem to feel that the changes that are recommended by the MR5 committee will make students less qualified for entry into medical school. "I was always better at Chemistry and science than in fuzzy subjects that didn't require logical thinking" and "Medicine is a scientific profession which requires the high-caliber minds who can think scientifically and objectively". And then there was my favorite, "Is this another attempt at the academia trying to brainwash students?"

I think much of this concern comes from a misunderstanding of the value of the test. It also may have something to do with changes in medical education and the practice of medicine that many physicians are not ready to embrace.  Medical school needs to do a better job of preparing students for practice in environments that are team-based and collaborative, and use information at the point of care.  The days of a physician who acts and practices alone and in a vacuum are gone. We need students who can work with nurses, pharmacists, physical therapists, social workers, and lay patient educators. (4)  The days of a physician who knows everything about everything that they do are gone. There is too much information.  We need students who can access information at the point of care and interface with electronic resources at the same time as they interact with a patient.

So, what should be in the MCAT. I would like MCAT to test some of the important aspects that are beyond the science. Science is not that hard to teach. Make the science portion pass / fail. If you meet this level, we think you can pass USMLE Step 1.  But many other important topics are harder to teach. Why can't the MCAT have more emphasis on ethics?  It could have more questions about health policy and the politics of medicine.  I would love to see a personality profile measure built into the test. What about service and altruism. What about team work? Are there measures of how collaborative people are in team situations? Now some people will say a test can be scammed for those kind measures. I am sure that is true, but with the numbers of people taking the MCAT and the amount of resources that are available, I bet a valid and reliable test could be constructed that would measure more than just knowledge.

(3)  Gough HG. Some Predictive Implications of Premedical Scientific Competence and Preferences. J Med Educ  1978; 53: 291-300.