by David Muller, MD, professor, Departments of Medical Education and Medicine, dean, Medical Education, and chair, Department of Medical Education, Mount Sinai School of Medicine of New York University, New York, New York.
Kudos to MR5 for their tireless efforts to renew and improve the MCAT, and kudos to Academic Medicine for publishing a fascinating set of articles on the MCAT and its impact. While the published articles do address a wide range of topics related to the MCAT, Academic Medicine did not publish as wide a range of opinions about the risks and benefits of the exam. Such articles could have been solicited from groups as varied as Admissions Deans, Deans of Academic Health Centers, medical students, undergraduate students, and national pipeline programs for students who are underrepresented in medicine. Only one article, by Eskander et al, attempts to present a balanced critique of the MCAT in an effort to make recommendations about its universal adoption in Canada. The authors come to the conclusion that, despite its predictive utility, its ability to accurately quantify academic aptitude, knowledge base, and critical reasoning skills, and some reassurance that it does not disadvantage students from minority groups, in balance, the MCAT carries more risks than benefits.
The fatal flaws of the MCAT are for the most part not inherent to the exam but rather the way it has come to be used. It was never intended to dictate the scope and depth of an undergraduate education; it was never intended to be used as a global measure of academic excellence or suitability for medical school; it was never intended to be used as a marker of excellence that determines national medical school rankings; and it was never intended to disadvantage certain groups of students by spawning an industry of preparatory courses that require enormous investments of time and money that many can ill afford.
I want to offer a modest proposal. I believe that most of the flaws described above exist because of the way scores are reported for the MCAT. No one would defend the notion that the current method of reporting scores accurately represents a student’s abilities as a medical student, physician or physician-scientist; that a 40 on the MCAT is in any way better than a 35. The data from Dunleavy et al reveal that 90% of students who score a 30 will have Unimpeded Progress in medical school. With a score of 25, Unimpeded Progress still hovers around 80%. According to data from Monroe et al, students who have scored 33-35 on the MCAT have at least a 67% chance of being accepted to medical school, and as high as an 86% chance if their GPA is greater than 3.80. The chances of being accepted drop more precipitously for MCAT scores below 24.
Instead of the current method of reporting scores I would propose the following: anyone who scores above a 33 would fall into the ‘Exceeds Expectations’ category; anyone whose score falls between 24 and 33 ‘Meets Expectations’; and anyone whose score falls below 24 ‘Does Not Meet Expectations’. I did not arrive at my cutoffs using a sophisticated formula. I also acknowledge that setting such cutoffs will invariably disadvantage some students. But just imagine the consequences of publicly reporting scores in these broad categories. Students would no longer invest the time required to achieve the highest possible score. The prep course industry’s influence would shrink dramatically, leading to some leveling of the playing field for disadvantaged students. US News and World Report would no longer have a stranglehold on the way schools define quality, allowing all schools to finally embrace holistic review without fear of adversely affecting a ranking system that none of us believe in.
Changing the way MCAT scores are reported will begin to undo most of the harm, while preserving the benefits.
Editor’s Note: Dr. Muller is involved in Mount Sinai’s Humanities and Medicine Program (HuMed), which offers a non-traditional admissions track to undergraduates majoring in the humanities and social sciences. Notably, HuMed does not require its applicants to take the MCAT. Dr. Muller has published on the program in Academic Medicine and the New England Journal of Medicine.