On the MCAT, and Getting In

Editor’s note: This month, AM Rounds is publishing a series of posts on the MCAT exam, in conjunction with Academic Medicine‘s collection in the May 2013 issue. To kick things off, Academic Medicine‘s Editor in Chief, Dr. David Sklar, shares his own memories of the MCAT and medical school admissions process, as well as his thoughts on the upcoming MCAT2015 exam. 

Like most practicing physicians, my memory of the application process to medical school has faded over the years, replaced with the memories of my patients, colleagues and the long nights in the hospital. After many years living in the skin of a doctor, I feel as if my life was always destined to involve medicine, and I cannot imagine another identity for myself. But there was a time when my course was not so clear, my destiny only a glimmer of a dream. No one in my family had ever attended medical school. Why should I think that I could? Doctors drove nice cars, lived in beautiful homes, went to country clubs, and played golf. I didn’t. The classes leading up to the MCAT weeded out many of my friends. Chemistry got my friend Charley. Organic got Jennifer and Tom. Physics finished off Tim, Felix and Charlene. Somehow Billy and I made it through and then there was the MCAT, and if we survived that, the interviews.

I remember the MCAT only in the vaguest of terms. I sometimes awaken from sleep in the middle of the night inside a dream in which I am pondering MCAT questions: a rolling pin was headed down an inclined plane at 3 degrees and there was an egg in the way that was a perfect sphere with a two-inch radius, but there was coefficient of friction that was slowing the rolling pin and I would need to figure out if the egg was going to crack. What sadist would construct such torture, these problems with tricks and booby-traps, equations and long sentences that made no sense? I remember the sweat and the smell of the room, the odor of animal fear. Each of us was a wildebeest on the plain, who had made it this far but now the lions would take some of us. Who would it be? It would happen suddenly and some of us would be gone; a letter in the mail would come with our score and we would know that all those years of premedical courses had been wasted, because of the MCAT.

And for those of us who survived the MCAT there was the interview. We all were ready for that special interviewer who had nailed a window shut and would ask us to open it and judge us by our response. What was the correct response? Were you supposed to laugh, to demonstrate a sense of humor? Were you supposed to persevere and keep trying to open that window to show your willingness to try in spite of the odds? Each of us accumulated stories of interview disasters. The wrong room, a mislabeled file, an elevator that did not work, an airplane that was late. We were hanging on by a thread that could be severed by the slightest perturbation of fate. At our interviews they might ask about what we wanted to do after medical school, and though we had nicely prepared answers, the truth was we just wanted to get in.

And so it was with some trepidation that I read the articles in the May issue of Academic Medicine that highlighted the MCAT exam, which has now undergone a revision process that will change the format and content of the exam. I was anticipating that I might break out in hives or begin sweating profusely as my body reacted to multiple articles about the MCAT as if to some massive load of antigen to which I was allergic. But my heart rate barely budged. I even thought the social sciences were a good addition to the test, considering how often I had to confront complex social issues affecting my patients’ health – far more frequently than an encounter with a rolling pin going down an incline. The articles stimulated my thinking about how the medical school application process attempted to balance numerous goals – fairness, intellectual rigor, personality, diversity – and how it has evolved over time. I recommend the articles that you will find in this special issue for both the scholarship and the provocative commentary.

But as I read through the articles, mostly I found myself feeling a little wistful, as one often does in thinking back on an event in one’s life that signifies a demarcation point. Before I made it past the MCAT my future was uncertain. Afterwards the future became more clear. There were still the interviews and the letters of acceptance yet to come. But once it was over, the MCAT was no longer a dangerous monster blocking my way in to medical school. It receded in the distance like a town you pass on a train on the way to your real destination. And now as I revisit it again through the eyes of expert guides, I realize it is neither a monster nor a town, but an important part of the process to create our future workforce. All of us in healthcare have a stake in the effectiveness of the MCAT and the admission process, and I hope our special issue will encourage meaningful conversations within our communities about it.

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