Revamping MCAT and Pre-Med Education

A special panel on Thursday proposed an overhaul of the Medical College Admission Test -- including changes that could encourage would-be doctors to take more social science courses as undergraduates and that might result in some minority and disadvantaged students having better tools to highlight their strengths.

Many parts of the MCAT wouldn't change, including the centrality of sections on the biological and physical sciences. But other changes could be significant enough, several experts said, to change the behavior of undergraduates and the advising that colleges give those seeking to attend medical school.

And aside from issues of what's being added, the plan would also remove the writing section of the test, which officials said has largely been ignored by medical school admissions committees. Even with the writing test gone however, the changes add up to a significantly longer MCAT -- with the 5.5 hour exam expected to grow by 90 minutes.

The plan released Thursday will undergo months of review by the Association of American Medical Colleges, which created the panel and which runs the MCAT. At this point, the likely launch for a revamped MCAT is 2015, 25 years after the last round of changes in the test.

The new MCAT would feature four sections:

• Molecular, cellular, and organismal properties of living systems.
• Physical, chemical, and biochemical properties of living systems.
• Behavioral and social sciences principles.
• Critical analysis and reasoning skills.

The first two sections are largely adapted from the current MCAT (although some of the science would be updated, and the proposal calls for more regular updates). A verbal section that has been part of the test will be transformed into the critical analysis section, and the behavioral and social sciences section will take the place of a general writing section.

Steven G. Gabbe, chair of the committee that drafted the plan and senior vice president for health affairs at Ohio State University, said that the changes -- especially the increased emphasis on the social sciences -- reflected the evolving nature of medicine.

"It's very clear that in this country a large proportion of illness is related to behavior and social and cultural problems," he said. "So we want to encourage the applicant to medical school to be thinking about those and reading about those early." Gabbe recalled that, as an undergraduate, he took a course in "social disorganization," and he said that the topics discussed -- poverty, alcoholism and drug abuse, among others -- are subjects future doctors need to understand.

The message for undergraduates (and their advisers) is "that you do need a solid foundation in the sciences, but you need more than that. You need to think critically and reason, and understand the differences in our society and the patients you see as a physician," Gabbe said. "We need people who are critical thinkers and people who have sensitivity and understanding of different cultures."

The writing portion is proposed for elimination, Gabbe said, because interviews with medical admissions committees found that very few institutions took it seriously. "It really didn't help us, even though it occupied a large portion of the test," he said. Medical schools gain no predictive validity from the writing test beyond what they already know from applicants' college grades.

The panel of medical educators studied and rejected one idea for a radical change in the test -- a shift from the current scoring (15 points for each section) to a pass/fail system. Gabbe said that the idea was seriously considered, but was rejected out of a concern that medical schools would not have as much information about applicants. Further, he said that some members of the panel were concerned that a pass level might end up excluding applicants "from groups underrepresented in medicine." With point totals, he said, medical schools can make their own judgments.

Diversity and Personal Characteristics

The AAMC and most medical schools have repeatedly stated that a more diversified medical student body would benefit patients and American society. But MCAT score gaps have been repeatedly cited as one challenge to admitting more minority students.

White and Asian scores are, on average, quite close, as are scores of men and women, but other ethnic and racial groups lag.

2010 Mean MCAT Scores by Gender and Race/Ethnicity

Other standardized tests for graduate and professional school admissions have also struggled with such gaps. One relatively recent solution has been the addition of standardized ways for either applicants or faculty members writing them letters of recommendation to -- in a consistent, comparable way -- comment on qualities that might show that a given applicant has potential, beyond what might be reflected in a test score.

The Educational Testing Service, for example, has created the Personal Potential Index as part of the Graduate Record Examination, and pilots have suggested that many more minority applicants do well on these measures than on traditional tests.

The AAMC looked at the PPI, as the ETS tool is called, and opted not to use it, but to consider similar ideas that might be customized for medical schools.

Karen Mitchell, senior director of the MCAT program, said that the AAMC has already been encouraging medical schools to engage in "holistic review" of applicants (not relying solely on the MCAT or any formula).

The recommendations issued Thursday called for the AAMC and medical schools to "[v]igorously pursue options for gathering data about personal characteristics through a new section of the [medical school] application, which asks applicants to reflect on experiences that demonstrate their personal characteristics, and through standardized letters that ask recommenders to rate and write about behaviors that demonstrate applicants’ personal and academic characteristics."

Further, the committee urges medical schools to "[m]ount a rigorous program of research on the extent to which applicants’ personal characteristics might be measured along with other new tools on test day, or as part of a separate regional or national event, or locally by admissions committees using nationally developed tools."

Mitchell said that there are several pilot projects that could be models for a new part of the admissions process. Seventeen medical schools in the United States and Canada are doing brief interviews of applicants involving various ethical and social scenarios to learn more about would-be students. Similarly, the medical school association has been studying initiatives in Belgium and Israel, where shifts in the admissions process have resulted in greater diversity of students.

Will the changes currently being proposed -- and possible additional changes designed to capture applicants' personalities and values -- result in more minority applicants scoring well and being admitted? "That's the million-dollar question," Mitchell said.

At the same time, she stressed that the AAMC had already studied all of the proposals being made to ensure that they would not place minority applicants at a disadvantage. For example, the association checked the curricular offerings of every historically black college to be certain that undergraduates there had access to the courses needed to prepare for the new MCAT.

Reactions From Critics and Test-Prep Experts

The National Center for Fair and Open Testing has periodically criticized the existing MCAT.

Robert Schaeffer, public education director of the center, said that the MCAT has been viewed as encouraging "memorization and regurgitation" and is "better at identifying science nerds than candidates who would become capable physicians well-equipped to serve their patients." The changes being proposed appear to be "responding directly" to these critiques, he said.

Schaeffer said that the AAMC was correct to suggest that medical schools not place too much importance on minor differences in MCAT scores. And this is an area, he said, where execution of the ideas, not just saying the right things in a report, is key. "Even the most carefully designed test will still be problematic if its results are misused as the sole or primary factor to make decisions about applicants whose test scores differ by a point or two," he said.

Kaplan Test Prep issued a statement Thursday afternoon suggesting that undergraduates start planning for the changes now, even if they are several years away. Many of the additional skills the MCAT would test are commonly taught in psychology and sociology courses, the statement said, so undergraduates should keep that in mind.

Judene Wright, national content director for the MCAT for the Princeton Review, said that the changes largely made sense to her. She predicted that they would result in "a better pool of applicants" for medical schools.

For medical school applicants, she said, there will be demands that they learn more than what has been considered the basic pre-med program. She also said that the committee was being honest about how the writing test wasn't being used. "We've been hearing that for years," she said.

The committee urged medical colleges to make test prep materials available at low cost, so that applicants will not be at a disadvantage if they can't hire tutors. Wright said she doubted those changes would have an impact on her business or that of her competitors.

She said that she regularly sees clients who studied on their own and scored at average levels, but want to enroll at a top medical school. She mentioned as typical a new student who scored 28 (combined) himself but wants to enroll at a medical school where the average is well into the 30s. Low-costs materials, she said, are unlikely to help such students achieve the changes in scores that they want.