Panel Recommends Changing Admissions Test
Medical Education Feature – July 2011
Tex Med. 2011;107(7);47-50.
By Ken Ortolon
Future physicians may be taking a different test to get into medical school than you did.
A special committee of the Association of American Medical Colleges (AAMC) is recommending major changes to the Medical College Admission Test (MCAT) to more closely align its subject matter with the science knowledge needed to practice 21st century medicine.
But while the proposed new MCAT increases the emphasis on biochemistry and cellular and molecular biology, it also sharpens the focus on critical analysis and behavioral and social sciences that affect the more human side of medicine.
Supporters of the recommendations say the proposed new test broadens the material premedical students need to be exposed to as undergraduates and helps prepare future physicians for the increasingly complex role they will play in medical care.
"The preliminary recommendations of the MCAT Review Committee mark an important transition," said Steven Lieberman, MD, vice dean for academic affairs at The University of Texas Medical Branch in Galveston. "They represent, both explicitly and implicitly, a broadening of the competencies needed to be a physician beyond the 100-year-old science-heavy model. This is an important recognition of the increasingly complex roles of physicians," said Dr. Lieberman, who also holds the John P. McGovern Distinguished Chair in Oslerian Medicine at the medical school.
Gary C. Rosenfeld, PhD, professor of pharmacology and assistant dean for educational programs at UT Medical School at Houston, sat on the review committee, informally known as the MR5 Committee because this is the fifth comprehensive review of the MCAT. He says the increased focus on behavioral and social sciences is a clear "value statement" of the role they play in modern-day medicine.
"I think the message is loud and clear from the public and from everyone else who has studied this matter that the behavioral sciences and an understanding of human behavior is critical to doctoring today," Dr. Rosenfeld said. "Not only do you need to be very, very good in terms of your knowledge of medicine, but you also have to be able to communicate and understand the ethical implications of what you're doing."
While Texas medical school admissions officers appear to support the proposed MCAT changes, Texas Medical Association's Council on Medical Education has yet to take a position on them.
Fifth Time Around
The MR5 Committee issued its preliminary recommendations in March after nearly three years of work. Karen Mitchell, PhD, senior director of the MCAT program for AAMC, says all standardized tests need to be reviewed every 10 to 15 years to make sure they "continue to test the most important things in the most capable ways."
The MCAT has been reviewed four previous times, but the last review was almost 20 years ago.
"The one thing everyone agrees is that it was time to reassess the MCAT," Dr. Rosenfeld said. "A lot has changed in scientific knowledge and medical education since that time."
Even some medical students say the test likely needed changes to more accurately reflect what is now being taught in medical school.
"I'm not convinced the MCAT is an accurate measure of ability to succeed in medical school," said Rachel Marinch, a student at UTMB. "While I believe in the need for a standardized test, I think the MCAT does not necessarily focus on the right areas."
Under the MR5 Committee's recommendations, the MCAT would still have four main sections:
- Molecular, cellular, and organismal properties of living systems;
- Physical, chemical, and biochemical properties of living systems;
- Behavioral and social sciences principles; and
- Critical analysis and reasoning skills.
The first two sections are largely adapted from the current MCAT, although some of the science would be updated with more emphasis on biochemistry and cellular and molecular biology. A verbal section that had been part of the test will be transferred to the critical analysis section, and a writing section is being scrapped in favor of the behavioral and social sciences section.
Dr. Mitchell says the writing test is being eliminated because few medical school admissions offices even use that section of the MCAT when evaluating potential candidates for medical school. That message came out loud and clear during some 75 outreach events the MR5 Committee held to seek input from admissions officers and others, she says.
"What they heard about the writing sample is that many admissions committees only use the writing sample for a very small number of applicants," Dr. Mitchell said. Those applicants might not have communicated very well in the interviews on campus, scored low on the verbal reasoning section of the MCAT, or have limited English proficiency.
Dr. Rosenfeld says additional material on biochemistry and cellular and molecular biology simply reflects how important those sciences have become in the modern practice of medicine, particularly as they relate to the emerging field of genetics-based treatments.
"We're reaching a point where that's basic information, basic content that is essential to the practice of medicine nowadays," he said. "These haven't been really looked at in any detail in previous exams and they are the fundamental courses for understanding the scientific basis of the practice of medicine."
Dr. Mitchell says a recent report by a group called the Scientific Foundation for Future Physicians Committee, cosponsored by AAMC and the Howard Hughes Medical Institute, also found that potential medical students need more exposure to biochemistry and cellular and molecular biology "because those two fields have exploded in recent years in terms of their relevance to medical science."
The Human Side
But while the hard science may be increasingly important, so too is a physician's ability to communicate and understand human behaviors that affect health and disease. Dr. Mitchell says the new exam will introduce material on cross-cultural studies, ethics and philosophy, population health, and more.
"I think it speaks to the national conversation and to the findings of a number of blue ribbon panels about the importance of behavior in health outcomes and sociological issues in health that have to do with family, neighborhood, nutrition, and so on. And, obviously, the population is changing demographically, so these issues are important to address.
Manuel Schydlower, MD, associate dean for admissions and professor of pediatrics at the Texas Tech University Health Sciences Center's Paul L. Foster School of Medicine in El Paso, says the emphasis on behavior and cultural issues is important in evaluating the "personal characteristics" of potential medical students.
"I think that's important because that will help identify individuals who will not only look at patients as disease processes but also look at them as persons."
That fits well with the Foster school's approach to analyzing applicants that goes beyond looking at MCAT scores and grade point averages, Dr. Schydlower says. "While we look at all aspects of the applicant to include academic credentials and capabilities in the sciences, we're also very interested in learning about critical thinking skills, problem-solving skills, the personal characteristics that make the complete doctor, the type of doctor that you or I would want for ourselves."
The Challenge Ahead
The MR5 Committee plans to seek opinions about its proposal from several different groups through this summer and fall, including medical school admissions officers, educational affairs officers, diversity affairs officers, faculty, and students. Final recommendations will be considered during the AAMC annual meeting in Denver in November. Then the AAMC Board of Directors must vote on the recommendations in February 2012. Once adopted, the new test would be implemented in 2015 after the new sections are developed and field-tested, Dr. Mitchell says.
If adopted, the new test will present some challenges for undergraduate premedical programs, Dr. Lieberman says.
"Premedical programs will not only want to review their science courses, but will also need to be sure the new behavioral and social science content of the exam is addressed in their curricula," he said.
MR5 Committee member Robert Hilborn, PhD, professor of physics and chair of the Science and Mathematics Education Department at UT Dallas, says the committee looked at the potential impact on undergraduate programs and the counseling that advisors will need to give premedical students. He says there may not be as big an impact on premedical students as some believe.
"We don't see a major shift in the course-taking patterns for most premed students as a result of these changes," Dr. Hilborn said.
In fact, Dr. Mitchell says it appears about two-thirds of premedical students already are taking biochemistry courses and a smaller number are taking cellular and molecular biology. Also, about two-thirds already take introductory psychology and sociology, she says.
Dr. Hilborn says the challenge for undergraduate faculty and advisors is to make sure their institutions are offering the course content that future physicians will need to prepare for medical school.
"What we're trying to do also is look at where the practice of medicine is going over the next couple of decades and from that try to give good advice to premedical students about what they need to get started on in order to be prepared to learn about the practice of medicine over those next couple of decades."
He says he already is working with UT Dallas premedical advisors to evaluate how well their current course offerings cover the skills, capabilities, and competencies premedical students will need to succeed on the proposed MCAT exam. "We found that at the 90-percent to 95-percent level, our current courses were already covering those skills and capabilities," he said. "So it will be easy for the prehealth advisors to have a list of these skills and capabilities and say here's what you have to do."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
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