COMMENTARY

New Admission Test Flawed, Won't Produce Better Doctors

Mira Michels-Gualtieri; Jacob M. Appel, MD, JD, MPH

Disclosures

February 10, 2020

Yet Another Barrier

SJTs also represent one more hurdle in what is an already challenging series of obstacles on the path toward medical school. Examinations may only be offered at certain times, and most charge fees. Although one additional barrier may not deter wavering applicants, the collective burden of requirements may do so. In addition, adding this test further increases the emotional and psychiatric burden on applicants. Although concrete data regarding applicant mental health are limited, various research has found that graduates from medical school have rates of depression and suicidality well above the rates of others their age. The goal should be to render the medical school application process less stressful, not more so.

Advocates of SJTs may argue that adding one more variable actually reduces the psychological weight of other admission requirements, such as the MCAT. However, anyone who understands medical school applicants should recognize that stress and anxiety are not a zero-sum game. Rather than worrying less about the MCAT, students are likely to have the same amount of anxiety on that test and then additional anxiety and effort associated with an SJT.

Perhaps the greatest shortcoming of SJTs is their opportunity cost. Like the current traditional science curriculum and the MCAT, tests such as CASPer fail to fundamentally change the nature of either the applicant pool or the body of students admitted; the applicants will largely be from the same groups as before, so any increased diversity will be marginal at best. There is a limit on how many additional requirements can be imposed in the admissions process; imposing SJTs may well prevent the creation of other more equitable measures.

Instead of SJTs or similar examinations, alternative medical school requirements could consider weighing public service work. This could be community outreach that exposes students firsthand to social or economic injustice or other areas that require improvement. It also could be the consideration of fluency in a second language, maybe even a language specific to patients from the area of the medical school they are applying. In New York City, for instance, patients may reap far more benefit from a student who can speak Spanish or Mandarin than one who can score well on a test. Needless to say, these requirements would also impose additional costs that might have biases of their own. However, they may more concretely measure the spirit of sacrifice we hope to see in physicians and may improve medical care in far more tangible ways.

Teaching ethics, professional conduct, and performance-based skills represent the core of medical school education. These skills should be taught in medical school and not be required prior to students attending medical school. A superficial understanding of these skills based on a single examination should not be a litmus test for future doctors. Rather, we should be focused on recruiting as diverse a student body as possible that mirrors the populations we serve. These physicians should possess skills that cannot truly be measured by any test: compassion, empathy, dedication, curiosity, and a breadth of life experience. Finding these candidates requires steadfast effort and a more holistic approach. Shortcuts such as SJTs are not likely to achieve these goals.

Jacob M. Appel, MD, JD, MPH, is the Director of Ethics Education in Psychiatry at the Icahn School of Medicine at Mount Sinai. Mira Michels-Gualtieri is a junior at Vassar College and a prospective medical student.

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