McGaghie, W.C. (2002). Assessing. Readiness for Medical Education Evolution of the Medical College Admission Test . JAMA, 288, 1085-1090.

PURPOSE: The attrition rate of 5% to 50% from US medical schools in the 1920s propelled the development of a test that would measure aptitude for medical studies. Since its development in 1928, the Medical College Admission Test (MCAT) has undergone 5 revisions. This article summarizes each version's definition of readiness for medical education in terms of test content, scoring rules, and suggested score use.

METHOD: The information from this article was derived from literature review, historical research in agency archives, and content analysis of tests and documents. Two primary data sources were used. First, historical publications about medical student selection in general and the MCAT as a particular selection tool have been reviewed to provide a developmental context for the MCAT. Second, archival materials from the AAMC, which has sponsored the MCAT from its beginning, have been studied and organized. These include versions of former MCATs, technical manuals, and test committee correspondence pertinent to MCAT evolution. This multi-method approach is used to account for and the reasoning behind modification of its several versions.

SUMMARY: The first phase of the MCAT was developed and implemented by physician and psychologist F.A.Moss and his colleagues between 1928 and 1946. The test was divided into 6 to 8 subtests that focused on memory, knowledge of scientific terminology, reading and comprehension, and logic. Results were reported as a single norm-referenced score that ranged in value from 0 to 385. The principal outcome of this early period of medical aptitude test development and use is that the national medical student attrition rate decreased.

The second phase, which was developed between 1946 and 1962, was reduced to 4 categories: verbal and quantitative skills, science knowledge, and added a category called understanding modern society. A single score was derived and reported for each subtest rather than for the test as a whole. The norm-referenced score scale was also revised to range from 200 to 800.

The third phase (1962 - 1977) of MCAT evolutions is more remarkable for its maintenance of the status quo in aptitude measurement rather than for any major changes. The basic structure and substance of the MCAT were retained from 1962 through 1977, although the major difference in the third version expanded the test's understanding modern society section to a broader test of general information. This suggests an even greater commitment by test designers to encourage a broad-based liberal education among prospective medical students.

Phase 4 (1977 - 1991) of MCAT evolution represented a major change from former approaches to measuring aptitude for medical education. MCAT content coverage was simultaneously expanded to cover a broader sample of scientific principles, reading skill, and quantitative skill while eliminating coverage of general liberal arts knowledge. Individual scores were reported for biology, chemistry, and physics rather than a composite sciences achievement score. The score scale was changed to 1 to 15 from 200 to 800in earlier versions. Test development gave direct and consistent attention to minimizing cultural and social bias.

The current version, beginning in 1991, has undergone another significant change. The current test has 4 sections, each with a representative subtest and reported score: verbal reasoning, biological sciences, physical sciences, and writing sample. Although it does not contain independent measures of either liberal arts or numeracy as separate categories, quantitative skills are needed to solve some of the problems in biological and physical sciences. However, its principal innovation is the writing sample section that requires each examinee to construct an original written response that is scored using expert judgment.

CONCLUSION: This brief review of the MCAT's evolution shows that the definition of aptitude for medical education has a consistent content core with many peripheral variations. The core consists of knowledge about principles of biology, chemistry, and physics according to the "state of the sciences" at various historical periods. Peripheral material that has moved in and out of favor includes verbal ability; nemeracy or quantitative ability; general information from the liberal arts, social sciences, and humanities; reading ability; and writing skills. The definition of aptitude for medical education embodied in successive versions of the MCAT has certainly met the pragmatic standard by achieving a nearly 0% rate of attrition for academic reasons. It clearly has an academic component that the MCAT has captured well in different ways in the successive versions. But it also has professional and personal components, as yet unmeasured or measured poorly via interview, that scholars repeatedly have argued are essential to medical education, clinical care, and medical professionalism.

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