AAMC Reporter: February 2009

AAMC Launches Review of MCAT Exam

The Medical College Admission Test® (MCAT) is undergoing its first comprehensive review in 15 years. Still in its initial stages, the review process will produce a revamped version of the exam no earlier than 2013.

"It is sound practice to periodically review standardized tests to make sure they address the most important things in the most accurate ways. The committee wants to know if the test tells admissions officers what they most want to know about the applicants to their schools," said Karen Mitchell, Ph.D., MCAT exam director for the AAMC. "They want to know if the MCAT exam is keeping pace with changes in medical education and practice."

A 21-member committee is overseeing the review process, generically known as MR5, signifying the fifth review in the MCAT exam's 80-year history. The committee consists of medical school deans, admissions officers, academic and student affairs professionals, and other medical education experts and officials. It also includes pre-health advisors and undergraduate faculty.

Although any idea or suggestion remains purely theoretical as the MR5 committee gathers information, MR5 Committee Chair Steven G. Gabbe, M.D., senior vice president for health sciences and CEO of the Ohio State University Medical Center, said the committee is generally interested in making the exam more sensitive to certain attributes that have emerged recently as keys to success, both in training and in practice, for prospective doctors.

"We should consider if the test should evaluate skills that physicians: collaboration, teamwork, service to the community, compassion, cultural competence, decision making skills, a commitment to lifelong learning," Gabbe said. "Can we utilize the MCAT to evaluate those qualities? The MCAT exam began strictly as a way to assess the ability of applicants to make it through the academic rigors of medical school. That has changed a lot. We want the test to reflect changes in premed education and in medical education that are necessary at this time."

The MR5 committee is talking with stakeholders both inside and outside the medical education community, and comparing the MCAT exam against other standardized tests.

"The committee wants to hear from medical schools and from the pre-health community," Mitchell said. "Our big message is that we're going to spend the next couple of years listening hard."

While committee members stress that there are no major problems with the substance of the exam, a constantly evolving health care system and society demand that the test be updated to reflect the changing times.

"The MCAT is good at telling you who is ready to succeed in medical school academically, but maybe we need to dream bigger," said Ricci Sylla, a third-year medical student at the University of Toledo College of Medicine and a member of the MR5 committee."The way that it tests is maybe not as reflective as it should be. It doesn't show students what medical schools want or expect. It should be more useful not just for admissions officers but for applicants."

At a fundamental level, the key knowledge base of a medical school applicant may be shifting away from pure biology to incorporate new branches of science.

"There are questions about whether we should focus on biochemistry, genetics, and biostatistics as areas for increased emphasis in the exam," Gabbe said.

With bedside manner a chief concern among today's patients, an applicant's communication skills and sense of community service are receiving heavier consideration in admissions offices. The essay-writing portion of the MCAT exam, committee members said, could be used to better gauge these skills.

"The questions posed in the Writing Sample do not relate to professionalism, but they easily could," said MR5 committee vice chair Ronald D. Franks, M.D., vice president of health sciences at the University of South Alabama College of Medicine. "These essay questions could provide a window not only into how an applicant communicates, but how an applicant thinks."

The MR5 process also may consider changes outside of the exam itself, including the use of technology to help test takers better prepare for the exam.

"Many students feel they need to take preparatory courses that cost thousands of dollars," Gabbe said. "Maybe we could develop new Web-based tools to help people better understand the MCAT without having to pay too much. For a student without a lot of money, the current preparatory courses can cause some real challenges."

Technology, of course, could play multiple roles in the exam's reorganization.

"With computers, you could show video clips, show patient vignettes, and do other things you can't do with paper and pencil," Franks said.

Committee members also want to make sure the test is as fair as possible. Committee members said they were interested in seeing more test score data for underrepresented minorities and others who cannot take preparatory courses or access meaningful educational advice.

"How does an applicant's background impact their performance?" said MR5 committee member David Acosta, M.D., associate dean for multicultural affairs at the University of Washington School of Medicine. "It's important to reflect on the data regarding underrepresented minorities and their performance on the exam....This is an opportunity to begin dialogue on these difficult kinds of topics."

Because the MCAT exam is generally considered, along with grade point average, to be a primary means of evaluating medical school applicants, committee members said the stakes are high for the exam to be the best tool possible for all involved.

"The MCAT helps define the next generation of physicians," Sylla said. "So we have to make sure it is as good as it can be. If you had the perfect test, what would it test, and what kinds of things could you get from it?"

—By Scott Harris