The MCAT is now required by all but
three of the 127 medical schools in the United States (only
the University of Rochester, Johns Hopkins and University of
Missouri, Kansas City, do not require it). In contrast, only
13 medical schools require the baccalaureate degree. This
implies that medical schools as a group value standardized
test scores more than a four-year college education in their
selection of applicants. Why might this be so, especially in
light of ongoing criticism of the MCAT as being only a
modest predictor of which students will succeed in medical
school and valueless in predicting what kind of physicians
they will become?
Picture the dilemma in the modern
medical school's registrar's office. Every year four to six
thousand applications arrive for one to two hundred freshman
class places. How to sort them out? Clearly, there are two
alternatives. Either you can have an admissions committee of
75-100 people so that each applicant will get personal
attention, or you can feed GPAs, MCAT scores and lesser
factors into a computer and review only those applicants who
make a cutoff. The former approach happens at a minority of
medical schools (the University of California-San Francisco
being one). The latter method is more universal, for obvious
reasons. Large admissions committees are unwieldy; smaller
ones function more easily. Consensus is easier to reach and
decisions among applicants can be made more quickly. But
small committees do not have the time to read through
thousands of applications. Hence, initial, non~personalized
screening.
Now, if students are going to be
judged initially by a computer there must be a way to turn
their academic achievements into a score. A formula is
devised, which will vary from school to school. Essentially,
grades are weighed along with MCAT scores. Some college
years may be weighed slightly more than others (junior over
freshman) and perhaps some majors over others or some
colleges over others, but this is minor compared with GPAs
and MCATs. Standardized test scores give medical schools an
impartial way to rate students from different schools, with
different majors, of different races and sexes. For all
their differences these premeds arrived at a testing center
at the same time to sit through an all-day marathon exam
that is designed
ultimately to lend an air of fairness
to the decision of who does and who does not get into
medical school.
I am no fan of the MCAT. I think it is
basically unfair because it favors students who are good at
taking tests (although it also gives the applicant from
Podunk U. a better chance). It does not differentiate
between good and excellent medical students and sheds no
light on an applicant's suitability to be a physician. The
only purpose it serves is to make the admission committee's
job easier. And it is also in the proprietary interest of
the American Association of Medical Colleges (AAMC) which
owns and writes the MCAT, arid keeps the fees.
Rather than rant about MCAT's
imperfections, it would be simpler to accept the reality
that taking the MCAT, like death and taxes, is inevitable
for anyone wanting to attend a U.S. medical school. The e~am
has changed and will continue to change as more people
demand that it become more relevant to the kinds of
physicians we would like to produce. But, for now, it is
important to do well enough on it to be invited to a
personal interview, where an admissions committee member can
see more of who you really are.
A question which arises from time to
time is whether it is possible to prepare for the MCAT,
particularly by taking an MCAT review course. I posed this
question to Dr. Thomas L. Pearce, premedical advisor at the
University of Virginia. This was his reply:
"Students must not expect that 'review'
MCAT courses are really science review courses. Usually they
are simple courses in examology; they try to teach students
how to take a specific test on a specific date, namely the
MCAT. This entails teaching test- taking techniques as much
as, or more than, reviewing the required premedical
sciences. Obviously topics covered in these 'review' courses
include premedical subjects, but the emphasis is on taking
the test, not reviewing comprehensively the material to be
tested.
"I believe that students are just as well
off, if not better off, by reviewing extensively and
independently the subject matter on which they will be
tested. All undergraduates I have taught these past 13 years
have been experienced test takers, for they have been taking
standardized tests for many years. I advise my students to
take any 'review' courses they wish; I never advise them to
rely completely on such courses. I urge them strongly to
review all their class notes, every page of their
introductory texts in biology, inorganic and organic
chemistry and physics, and to buy the science review book
written by James Flowers, available in paperback for $18.00.
In addition I urge all of them to buy the MCAT Student
Manual (2nd edition), which contains useful information
about parameters of subjects on which they are to be tested
as well as a complete MCAT, used several years ago. There
are several books available which contain only practice
MCATs; generally these are good to use as well, but only
after the review studying has been done."
An interesting series of three
articles about the MCAT appeared in the February 9, 1984,
issue of the New England Journal of Medicine. It is, as far
as I'm concerned, required reading for all premeds. The
Journal received two unsolicited essays lambasting the MCAT.
The third article was invited from the AAMC by the Journal
to counterbalance an overwhelmingly one-sided
view.
One essay, by Robert D. Powers, M.D.,
is particularly interesting. Dr. Powers, a young
physician-in-training at the University of Virginia, had the
opportunity to be the residents' liaison on that school's
admissions committee (some schools even have upper- class
medical students serving as members). Having last taken the
MCAT in the spring of 1974 as a college junior, and
recognizing that it had changed radically since then, Dr.
Powers decided to take the exam again. After all, he was
judging applicants on the basis of a test of which he, and
all the other committee members, had little firsthand
knowledge. So he sent in his application form, picture and
filing fee and received back one admission ticket to the
MCAT. The following abridged description of the exam is Dr.
Powers':
The MCAT Revisited
"Exam day arrived, a rainy Saturday in
early April. The first thing that struck me when I showed up
at the biology building was that the students were taking
this very seriously. It may be the only class of the year
for which everyone is punctual. Although the information
folder had advised us to bring two pencils, most examines
came with five or six, just to be sure.
"To enter the room to take the test you
must first pass a checkpoint where the picture you have sent
with your application is compared with your face as well as
with another picture identification card that you must have
with you. You are then given a signature card that you sign
at that point and again three more times during the day. All
this security is a little unnerving. I wonder whether it's
based on actual instances of cheating or just the paranoia
that surrounds major events like this.
"The registration and identification
process began at 8:00, but we did not begin to take test
until 9:15. The first part ran until 11:00 a.m. It was the
science-knowledge portion, consisting of 38 biology
questions, 47 chemistry questions, and 44 physics questions.
The biology questions were relatively straightforward and
quite broad; someone who has taken a survey course and a
cell-biology course could do pretty well on this section,
although 38 seems like a very small number of questions to
assess someone's knowledge of such a diverse field. The
chemistry questions were tough, weighted toward
thermodynamics, kinetics, and organic reactions, although
there were a few simple equations and neutralization
problems thrown in. At this point in the test I realized
that I was being expected to remember details to a much
greater extent than I had anticipated. I had trouble because
I was unable to figure out the various valance states of the
element manganese. Amazingly, it seemed that four or five
questions revolved around knowledge of this particular fact.
The physics questions equally demanded rote memory, testing
recall of information rather than problem-solving ability.
My principal handicap here was failure to remember the
proper formulas for projectile problems. In numerous cases I
was called on to calculate velocity, trajectory, or
acceleration of various thrown and falling objects. In
addition I was expected to know the effects of various types
of lenses and mirrors on the size and orientation of the
images they project. This was quite confusing and I had
trouble finishing.
"The second morning session was a
90-minute test entitled 'science problems.' This test
allegedly measures problem-solving ability rather than
memory of facts, but I saw no difference between these and
the science-knowledge problems. The questions were framed so
as to include gratuitous references to health-care
applications of chemistry and physics, but they were really
just the same old projectile problems dressed up in medical
outfits. Instead of dealing with cannonballs falling out of
towers, we were asked to calculate trajectories of
orthopedic traction weights falling off the ends of beds.
Despite the attempts to make this section interesting and
relevant, the test taker was doomed unless he or she could
easily recall arcane formulas and laws of chemistry and
physics. These questions easily filled the allotted time,
and many in the room did not finish.
"My feeling about the entire morning
portion of the test was that it measured recall of facts
rather than cognitive function or reasoning ability. It was
dry, dull and by and large totally unrelated to the practice
of medicine. Unfortunately, it brought to mind the usual
approach to the basic sciences in medical school: memorize
for the exam, then forget; for it seems you rarely use the
facts again.
"Lunch ran from 12:45 to 1:45 p.m.; if
you were not back in your seat promptly, they voided your
morning test and sent you home. At the break the crowd was
subdued but relieved that the ordeal was half over. I
overheard one student say that this would be his only
attempt; if his scores were bad, he would rather not be a
doctor than go through the test a second time.
"The afternoon session consisted of
nearly three hours of reading and quantitative-skills
testing. There were 67 questions in each category, for a
total for the day of 327 problems. The reading section was
much more pleasant than the morning science tests. It
consisted of paragraphs dealing with both scientific and
nonscientific subject matter. The questions related to this
material, in most cases requiring that facts and
interpretations be gleaned from the information presented.
This forced the test taker to read critically and to be
certain that concepts were adequately delineated and
documented. Most of the questions were quite
straightforward, drawing more on deductive skills, reasoning
and problem-solving capacity than on knowledge of vocabulary
or grammar. I found this section of the test to be much more
relevant to the clinical years of medical school and the
actual practice of medicine than any of the morning test
sections.
"It was evident as the afternoon wore on
that fatigue was a major concern for the test takers. This
test is a marathon, and endurance certainly has a major role
in the outcome for some people. Whether by design or by
accident, the MCAT writers had saved the most
thought-provoking questions until last. The quantitative
section involved true problem solving, not the regurgitant
performance required in the science-problem section. It was
similar to the reading-skills test in that we were presented
with information and then asked to draw conclusions and
support or disallow statements made about the data. Instead
of short paragraphs of written information, the material in
this section was all graphic: pie charts, bar graphs,
tables-virtually every method of presenting data was used in
preparing the questions. Much of it was very similar to what
one sees in the medical literature: an explanation of
methods followed by data, then a set of conclusions that the
reader is invited to agree or disagree with. Each problem
contained the information needed to solve it; there was no
need to recall dusty old formulas or definitions. This I
also found very relevant to the sort of decision making that
we are trying to educate our students to master; the great
majority of the problems involved synthesis of information
and deduction of justifiable conclusions.
"When the test was over it was after 5:00
p.m. The end of all the questioning was signaled by screams
of celebration and the sound of champagne corks popping.
Despite the fact that I had little at stake except pride, I
was quite relieved. This was a long, hard test and not a lot
of fun even without the pressure of having to do well. It
announced that there would be an MCAT survivors' party; all
were invited to drown their sorrows in beer.
"I set out to get an idea of how we
should interpret applicants' MCAT scores. I wondered whether
we used them in a reasonable way or wrongfully discriminated
against those who did poorly and favored those who did well.
After taking the test, I have these thoughts:
"The science portion is not of much value
except to gauge the preparation of a student in some very
narrow and quantitative aspects of chemistry and physics. In
this respect, it does allow us to compare similar courses at
different colleges.
"The science portion also tests memory to
an extreme degree; the student who is a year or two away
from science courses and does not prepare by memorizing
formulas is doomed. This is very important to keep in mind
when one is evaluating the applicant who has been out of
college for a while. Beyond these uses I don't think the
science and science-problem sections are worth much.
However, the questions are like basic-science examination
questions in medical school, and I would expect people who
do well on the science portion of the MCAT to do well in the
basic sciences if they are motivated enough to memorize
lists of facts. As long as we continue to demand this of
them in the first two years of medical school, this portion
of the test will be a reasonable measure of their ability to
succeed. The ability to do well on these sections may thus
correlate with suitability to be a physician.
"The afternoon sessions are quite the
opposite. If the morning sections correspond to the basic
sciences, the skills tested in the afternoon relate to the
clinical years of medical school and the actual practice of
medicine. Information is available and accessible, but the
data must be analyzed and decisions made individually. From
this point on, I will regard performance on the reading and
quantitative sections much more highly than I have in the
past.
"In comparing this examination with the
one I took in college, I have had most of my suspicions
confirmed. I was sorry to see the general information
section eliminated during the MCAT revision in the late
1970's, and I am even sorrier that it has not been restored
in any form as yet. Despite the strengths of the afternoon
section, it is still possible to do very well on this entire
examination without any knowledge of music, art, philosophy,
religion, literature, history, current events, gardening,
hunting, fishing, or athletics. Although familiarity with
any or all of these subjects is not essential to being a
competent physician, I think that most patients would agree
that a doctor who can relate to their interests and problems
outside the office is better able to care for them than one
who cannot. It is unfortunate that the call for more
humanism in medicine has been answered by the almost
complete elimination of the humanities from the only test to
which all medical-school applicants have a common
exposure."
Dr. Powers goes on to lament "the
absence of the non-academic side of life" from the MCAT and
states that letters of reference from premedical advisors
have, along with everything else, become inflated with
praise and superlatives, rendering them at times unreliable.
The personal interview may leave lingering
doubts as to which people may be good
technicians but poor physicians. Dr. Powers ends with a plea
to the AAMC to devise a more~ well-rounded examination that
does more than measure proficiency in science. In fact, the
spring 1985 and 1986 MCAT will feature a forty-five minute
essay subtest in an attempt to gather some data about the
communication and reasoning skills of applicants. This
inclusion is being undertaken on a pilot basis to determine
if it provides information useful in admissions decisions.
However, a total exam overhaul is still a long way off. In
the meantime, don't hold your breath. Get crackin' for the
MCATs!