The New MCAT: Is Today's Exam Right for Tomorrow's Physicians?

Shiv M. Gaglani

Disclosures

June 24, 2015

Nearly 25 years since its last revision, a new Medical College Admission Test (MCAT) made its debut in April of this year. Although much has been written about the changes and the reasons behind them, including commentaries in the New England Journal of Medicine (NEJM), the Association of American Medical Colleges (AAMC) website, and Academic Medicine, it is too early to tell whether the new exam fulfills its purpose of helping to select medical students who are most likely to meet the needs of an evolving healthcare system. As the authors of the NEJM perspective write,

It may be as important for aspiring physicians to understand patients' social, environmental, and personal characteristics and complex health care systems as to grasp basic biologic processes.... Using the MCAT to screen for basic behavioral and social science knowledge is an important step in producing better-prepared physicians.

Given my roles as a medical student at Johns Hopkins and premedical resident tutor at Harvard College, I became very interested in learning more about the exam and helping my premedical students navigate these uncharted waters. But before I delve into the new MCAT itself, I wanted to discuss the broader question of the validity of high-stakes summative examinations for screening future clinicians.

One surprising commonality between all levels of education, from primary school to continuing medical education, is the intense controversy surrounding high-stakes summative exams. This debate encircles virtually every summative exam, ranging from the SAT and ACT to the board recertification exams that practicing physicians are required to take, and raises the question of whether summative exams such as the MCAT are even appropriate tools for the admissions process.

As I have argued in Quartz, I believe that they are appropriate, because they serve two important purposes: (1) ensuring an essential body of knowledge or skill before advancing a student to the next level in her education, and (2) providing an "objective" measure to compare applicants in situations where demand for positions exceeds supply.

The legitimacy of the summative assessment depends on how well it meets both of these goals. The latter goal is necessary but not sufficient, because we could use a completely arbitrary objective measure to determine whether a premedical student should be admitted to medical school. Whereas the former goal helps us arrive at the million-dollar question—What is the essential body of knowledge or skill that we should require of our entering medical students?it too is necessary but not sufficient, because the summative exam is the only measure we have to objectively compare applicants.

Indeed, the new MCAT places more emphasis on the percentile rank for admissions purposes as opposed to the raw scores, meaning that the MCAT still ultimately serves as an objective benchmark for comparisons. On this point, when I asked the AAMC's senior director of admissions testing services, Karen Mitchell, PhD, about reactions to the new MCAT, she replied that, "Medical school admissions officers will meet in Miami in June to begin developing plans for how they will use scores from the new exam in the 2016 selection process."

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