Proposed changes would broaden MCAT's scope

Recommended revisions to the Medical College Admission Test are designed to broaden what is expected of prospective medical students and ultimately attract a wider range of medical school applicants, says the Assn. of American Medical Colleges.

The goal is to transform the test to meet the needs of the nation's changing health care system, said Steven G. Gabbe, MD, who chaired the 22-member AAMC advisory committee appointed in 2008 to review the MCAT.

"The committee believes these proposed changes will preserve what is best in the exam, eliminate what is not and enrich the MCAT by emphasizing the concepts future physicians will need to master," said Dr. Gabbe, senior vice president for health sciences and chief executive officer of Ohio State University Medical Center.

The recommendations include adding a section on behavioral and social sciences and testing students' reasoning skills in subjects such as philosophy, cross-cultural studies and population health. The AAMC also is seeking to eliminate the writing sample and expand the overall testing time by about 90 minutes, according to the 14 recommendations released March 31.

If approved by the AAMC board of directors in February 2012, the changes would take effect in 2015. It would be the fifth MCAT revision since the test was first administered in 1928.

Broader test for a broader student

Most of the changes are positive and would expand the scope of the MCAT beyond its emphasis on the clinical sciences, says the American Academy of Family Physicians.

"It will attract a broader-educated student, rather than students that predominantly focus on science in their preparation," said AAFP President Roland Goertz, MD. "Generally speaking, those kinds of students tend to stay in direct clinical care delivery."

Such students are more apt to become primary care physicians, which are sorely needed nationwide, Dr. Goertz said.

The AAMC's MR5 Committee, which developed the recommendations, held more than 75 outreach events, received input from numerous groups and reviewed more than 2,700 surveys from undergraduate and medical school faculty, administrators, residents and medical students.

Feedback has been positive, said Karen Mitchell, PhD, AAMC senior director of admissions testing services. "The goal is to bring the students to a solid starting point for what they will need to know for medical school," she said.

The recommendations include updating the MCAT's two natural sciences sections and testing applicants' scientific thinking and research skills.

"Rapid changes in all scientific fields, the impact of behavior on health and a more diverse population require tomorrow's doctors to be more broadly prepared," said Ronald D. Franks, MD, MR5 Committee vice-chair and vice president of health sciences at the University of South Alabama.

Impact of changes unclear

One recommendation that is meeting some objection from the AAFP is elimination of the writing sample, which gives a sense of how well applicants communicate and organize ideas, Dr. Goertz said. "We believe a writing sample would still be beneficial," he said.

Mitchell said the committee made the proposal after learning that many admissions committees consider the section for only a small number of applicants.

Clara Callahan, MD, dean of students and admissions at Jefferson Medical College of Thomas Jefferson University in Philadelphia, also questions getting rid of the writing sample, but said it has limited use. "Unfortunately, I don't think many schools used that, so it's not surprising they eliminated that," she said.

Dr. Callahan wrote a study in the June 2010 issue of Academic Medicine that found the MCAT has remained a solid predictor of students' performance in medical school and beyond. Whether that would remain true under the new recommendations remains to be seen, she said.

The changes aren't likely to alter the way many students prepare for the MCAT, because a lot of them receive broad undergraduate educations. "It's probably going to mesh with many students we see now," Dr. Callahan said. "Many, many people who come to medical school are not science majors."