Will bet­ter test mean bet­ter docs?

Re­vised test to fo­cus on more than sci­ence acu­men

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For July 2020, some en­vi­sion a new type of doc­tor en­ter­ing the work­force: One who may not write very well but has ex­ten­sive bio­chem­istry knowl­edge, has a solid grasp of be­hav­ioral and so­cial sciences, and has crit­i­cal anal­y­sis and rea­son­ing pow­ers never seen be­fore in the halls of medicine.

A 21-per­son As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges com­mit­tee be­gan the pre­lim­i­nary work on cre­at­ing this vi­sion three years ago, and the panel’s rec­om­men­da­tions for re­vis­ing the Med­i­cal Col­lege Ad­mis­sion Test will be put to a vote dur­ing a Feb. 15-16 meet­ing of the AAMC board. If ap­proved, a new test will be built and would be ex­pected to be ready for stu­dents to take in 2015.

Some say the new test may re­place the stereo­typ­i­cal med-school ap­pli­cant pool from the driven, Type A per­son­al­i­ties who know just about every­thing ex­cept how to re­late to other peo­ple with a new breed of stu­dent full of em­pa­thy and com­pas­sion. Oth­ers say it may lead to the Type A’s be­ing bet­ter trained to deal with oth­ers who don’t match their in­tel­lect, but at the ex­pense of ei­ther push­ing non­science ma­jors away from con­sid­er­ing medicine or forc­ing them to take five years of un­der­grad­u­ate school­ing in or­der to squeeze in the re­quired course­work.

And then there are those who say, “Re­lax, it’s just a test.”

The ef­fort has been dubbed “MR5” be­cause, ac­cord­ing to the AAMC, this is the fifth com­pre­hen­sive re­vi­sion of the MCAT since its orig- inal ver­sion was used in 1928. The cur­rent edi­tion has been in use since 1991, and it’s likely that a re­vised test will be used un­til 2030. While peo­ple are gen­er­ally aware of the test’s strengths and lim­i­ta­tions, there ap­pears to be a de­sire to use it for some­thing deeper than just mea­sur­ing a stu­dent’s abil­ity to me­morize sci­en­tific facts.

Dr. Darrell Kirch, the AAMC’S pres­i­dent and CEO, touched upon this in his ad­dress at the or­ga­ni­za­tion’s an­nual meet­ing this month.

“The MCAT exam is cer­tainly a re­li­able tool to mea­sure cog­ni­tive abil­ity—that is, ‘bright­ness’—in cer­tain ar­eas, but we all know how lit­tle it tells us about the at­ti­tudes, val­ues and ex­pe­ri­ences that may make an ap­pli­cant truly among the best,” Kirch said in his speech.

“Our own AAMC pub­lic opinion sur­veys show this di­chotomy. While the peo­ple we serve have a high level of con­fi­dence in the med­i­cal knowl­edge of our grad­u­ates, a sig­nif­i­cant per­cent­age of them ex­press real con­cern about the bed­side man­ner of the doc­tors we pro­duce. In essence, the pub­lic is more con­fi­dent in our abil­ity to bring the ‘bright­est’ to medicine than in our abil­ity to find and ed­u­cate the ‘best.’”

Rec­om­men­da­tions for the new exam call for elim­i­nat­ing a re­quired writ­ing sam­ple, and cre­at­ing four test sec­tions that would cover bi­o­log­i­cal and bio­chem­i­cal foun­da­tions of liv­ing sys­tems; chem­i­cal and phys­i­cal foun­da­tions of bi­o­log­i­cal sys­tems; psy­cho­log­i­cal, so­cial and bi­o­log­i­cal foun­da­tions of be­hav­ior; and crit­i­cal anal­y­sis and rea­son­ing skills.

The last two sec­tions would be new ad­di­tions to the test and, ac­cord­ing to an AAMC MCAT “pre­view guide,” the first three sec­tions of the pro­posed test are or­ga­nized around “big ideas” in sci­ence and em­pha­size “deep knowl­edge of the most im­por­tant sci­en­tific con­cepts over shal­low knowl­edge of many dis­crete sci­en­tific facts.” The pre­view guide also states how, “Be­fore draw­ing a con­clu­sion, sci­en­tists iden­tify key assumptions and eval­u­ate ev­i­dence rel­a­tive to their claim.” The fourth sec­tion mea­sures an ap­pli­cant’s abil­ity to do so.

In ad­di­tion to the main panel work­ing on the re­vi­sions, a smaller group formed an “in­no­va­tion lab” that last month is­sued its own rec­om­men­da­tions about what “per­sonal com­pe­ten­cies” a new test should mea­sure in or­der to pre­dict suc­cess­ful per­for­mance in med­i­cal school. These six com­pe­ten­cies were iden­ti­fied as in­tegrity and ethics; re­li­a­bil­ity and de­pend­abil­ity; ser­vice ori­en­ta­tion; so­cial, in­ter­per­sonal and team­work skills; de­sire to learn; and re­silience and adapt­abil­ity.

‘Bal­anced prepa­ra­tion’

Ac­cord­ing to Karen Mitchell, MCAT se­nior di­rec­tor and staff leader of the MR5 ini­tia­tive, 90 outreach events were held, and the com­mit­tee re­ceived plenty of rec­om­men­da­tions.

“There cer­tainly was a wide range of views of what the MCAT should do and test for,” Mitchell says, in­clud­ing those who thought med­i­cal-school stu­dents should be re­quired to have ad­vanced sci­en­tific knowl­edge upon ar­rival and those who sought a more “well-read and well-rounded” ap­pli­cant pool who could be taught the sci­ence they need to know when they got there. “I think cer­tainly one of the big mes­sages the test is com­mu­ni­cat­ing is to have bal­anced prepa­ra­tion,” Mitchell says, adding that the new MCAT will re­quire ap­pli­cants to demon­strate “not only mas­tery of the con­tent, but be­ing able to use that knowl­edge” with sci­en­tific prob­lem-solv­ing and sta­tis­ti­cal anal­y­sis.

Dr. Ge­orge Thibault, pres­i­dent of the Josiah Macy Jr. Foun­da­tion med­i­cal ed­u­ca­tion ad­vo­cacy group and former chief med­i­cal of­fi­cer at Brigham and Women’s Hos­pi­tal in Bos­ton, says he’s en­cour­aged by the work of the MR5 panel, but he thinks the test’s po­ten­tial im­pact needs to be kept in per­spec­tive and that the re­vised MCAT can­not be seen as the “end all and be all” in de­ter­min­ing how to de­velop a physi­cian work­force that will meet so­ci­ety’s near-fu­ture needs.

“I don’t think the test alone will be a suf­fi­cient tool to bring about the change. … Tests are not all that good or pow­er­ful—no mat­ter how well-de­vised,” Thibault says. “Re­vi­sion of the test is a small piece of a holis­tic process.”

Richard Mac­don­ald, pro­fes­sor of bio­chem­istry and molec­u­lar bi­ol­ogy at the Univer­sity of

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