Reviews |  Medical schools should reduce the importance of standardized admission tests

Reviews | Medical schools should reduce the importance of standardized admission tests

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Alessandro Hammond is a student at Harvard University and a researcher in oncology and hematology at Boston Children’s Hospital. Cameron Sabet is a graduate student at the University of Pennsylvania studying religious studies and medical ethics.

The American Bar Association recently announced that, to remove entry barriers for disadvantaged students, it would drop the LSAT as a requirement for future law school applicants. Now is the time for medical schools to take a similar step, for a similar reason, and rethink their reliance on the Medical College Admissions Test, or MCAT.

The American Association of Medical Colleges (AAMC) currently requires medical school admissions teams to include the MCAT score among the many variables they use to assess applicants. Proponents tout the test as the great equalizer in candidate skill assessments – leveling the playing field for students who come from diverse academic backgrounds and testing their basic science knowledge.

However, like the LSAT and SAT for college admissions, the MCAT clearly favors white applicants who have the wealth and resources to help them earn competitive scores on the test — and disadvantages those from a lower socio-economic background. – economically disadvantaged. Affluent candidates can gain an advantage through books, courses, and coaches — and even retaking the test, which is one of the most expensive standardized tests, for a fee of $330 (compared to $215 for the LSAT and $60 for the SAT), multiple times to keep improving their score.

Seats at top medical schools often require scores at the 99th percentile, although the median MCAT score for white medical students is the 83rd percentile (512.6). For black students, this is the 61st percentile (505.7); for Hispanics, the 65th percentile (506.1); and for American Indians or Alaska Natives, the 58th percentile (504.9). Looking at these numbers, it’s clear that medical schools understand that minority students meet a certain proficiency threshold even though they score lower. It’s time to codify this tacit recognition that these racial differences in scores reflect meaningless socio-economic privileges that don’t define candidate worth. We’re not proposing to eliminate the test because it measures basic skills — organic chemistry, general chemistry, biology, etc. — required for medical school. But the AAMC should make the MCAT a pass/fail exam to remove barriers for disadvantaged minority applicants, while ensuring students are prepared for medical school.

This is a critical step if the medical profession is to diversify its ranks of physicians and build trust among underserved minority communities. Given the history of academic medicine’s exploitation of black patients for research and eugenics, this distrust is not entirely misplaced. Even today, black patients generally fare worse than white patients. A Stanford University study found that black patients have better health outcomes when paired with doctors of the same race, and black doctors take more detailed notes on black patients than their counterparts whites. African Americans are twice as likely to trust information provided by someone of their own race. This relationship of trust affects people’s overall trust in medicine: a poll conducted during the first year of the covid-19 pandemic, for example, showed that only 14% of black and 34% of Latinx respondents did confidence in mRNA vaccines.

Through a fairer medical school admissions process, we can address these downstream demographic gaps in our medical workforce. Currently, black doctors, for example, represent only 5% of this workforce. This percentage has remained stable since the 1970s, but it need not continue to do so. In fact, the proportion of black medical school enrollees increased between the 2020-21 and 2021-22 admissions cycles, a result of efforts by historically black colleges and universities to improve black representation in health care. . HBCUs recognize that MCAT scores do not tell an applicant’s entire story and have implemented solutions for more comprehensive assessments of the application. For example, the Howard University College of Medicine offers an unconscious bias training course for interviewers and blinds college MCAT scores and GPA — two of the most important metrics used in the pre-interview screening process — until after interviewing a candidate.

A 2015 study determined that there was little, if any, correlation between the MCAT and performance in medical school and beyond. Since the MCAT does not accurately predict clinical excellence and is not a determinant of candidate quality, the AAMC should recognize that this standardized exam is an indeterminate predictor of success. As British economist Charles Goodhart noted in a 1975 publication, once a metric becomes a target, it is no longer a good measure.

More importantly, the numerical measures do not test for the traits patients seek in their ideal physician: As a 2006 Mayo Clinic study of 192 patients found, empathy, openness, and respect are among the qualities that patients seek most in their doctor. In their admissions policy, medical schools should place greater emphasis on increasingly recommended or required interviews, essays, and personality tests such as Casper or the AAMC’s Situational Judgment Test, which better highlight the crucial traits of a successful physician than the MCAT.

Unless the AAMC acts now to eliminate graduated standardized testing requirements, the medical community will continue to struggle with the challenges of building trust in minority communities.

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