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A Word From the President: A New Paradigm for Evaluating Future Physicians

AAMC Reporter: May 2015

When registration for the new MCAT® exam opened in February, I was gratified to see that nearly 17,000 aspiring physicians signed up within the first 24 hours to take the new test. The first administration of the new test in April—with 7,500 examinees—was the culmination of many years of work to make the exam a better assessment of the knowledge and abilities that future physicians will need to practice medicine in a changing health care landscape.

The project to redesign the MCAT exam was led by a diverse committee of medical school deans, admissions officers, educational and student affairs deans, diversity officers, medical school faculty, pre-health advisers and other undergraduate faculty, a resident, and a medical student. In an intensive effort to identify the knowledge and skills that lead to success in medical school, the committee interviewed more than 2,700 medical school and baccalaureate faculty members, residents, and medical students from across the country.

One key insight from the committee’s assessment was the need to evaluate medical school applicants on their awareness of social and behavioral determinants of health. As a result, the new MCAT exam introduced a section, “Psychological, Social, and Biological Foundations of Behavior,” to test students’ understanding of how behavior, culture, bias, poverty, and other concepts from psychology and sociology affect health and health status. The new test also asks students to demonstrate they can use this knowledge to solve complex problems. Like the natural sciences sections of the new exam, this section is less about what students know and more about how they can use what they know.

With these modifications, the updated MCAT exam has become a more powerful tool to provide data enabling medical schools to select students who will succeed in the future health care environment. We all want doctors who see the whole patient and recognize how life experiences contribute to patients’ health and well-being. To produce doctors with these qualities, we must choose incoming students with the necessary foundational knowledge and skills.

The new MCAT exam is just one component in an improved admissions toolbox that the AAMC is developing for medical school admissions officers. To provide the basis for a holistic review of medical school candidates that considers experience, attributes, and academic performance, the AAMC has identified 15 core competencies for incoming medical school students. These include science and reasoning skills as well as interpersonal and intrapersonal competencies, such as ethical responsibility and capacity for improvement.

To enable admissions officers to get a sense of more elusive qualities successful physicians need—social skills, oral communication, dependability, and resilience, for example—the AAMC is developing and testing a situational judgment test (SJT). The SJT would provide students with scenarios relevant to the core competencies and ask them to rate the effectiveness of multiple possible responses in each example. We also are considering the possibility of employing other tools, such as standardized Web-based interviews, which would support admissions officers’ efforts in making more informed decisions when extending invitations for formal on-site interviews.

Developing and implementing these initiatives will take time and significant input from our constituents and other stakeholders if we are to produce an approach that will obtain a true and nuanced assessment of a candidate’s qualities. One step we are taking right now to support admissions officers in the decision-making process involves better use of our rich stores of data about the attributes and experiences of past applicants and how those factors have corresponded to future specialty choices, locations of practice, and service to the community. Given the advances in data analytics, the AAMC is examining additional ways to sift through the data collected along the continuum of medical education to help admissions committees select the future physicians of our country more effectively.

Looking ahead even further, we should be able to apply what we learn from these new approaches in evaluating medical school applicants to the selection of residents by program directors. For example, it is easy to visualize a more advanced version of a SJT that could be taken by medical students and become part of the data set by which their applications for a residency position are assessed. Similarly, data analytics applied to residency applicants will have an even richer pool of complex data sources from which to draw in supporting selection decisions.

As technology improves and tools to support medical decision-making get better, some people have asked me whether the doctor of the future will be replaced by a “Watson-like physician”—a software program with all the answers. With more advanced technology, doctors will indeed have access to better information and decision support tools. But I believe health care decisions based on the relationship with the patient as a whole person—not just in terms of his or her illness, but within a social and cultural context—will continue to require the kind of well-rounded physician that a holistic admissions process yields. Even the most avid proponents of technology do not believe that a device can replace genuine human empathy.

Establishing a broader view of scientific competencies required for physicians also creates room for new types of premedical courses—and maybe even a new type of student will emerge. My hope is that, with the revised MCAT exam and other tools such as holistic review and SJTs, the medical student applicant pool will widen and become more diverse. Diversity of experience can only benefit the medical community and our patients.

Future physicians need to know how biological systems work, but they also need to understand how people work, think, and make decisions. By expecting prospective doctors to demonstrate a broadened base of competencies before they even arrive at medical school, we can be sure that we are training the doctors that patients will need for the future.

Darrell G. Kirch, MD

Darrell G. Kirch, MD

“Future physicians need to know how bodies and systems work, but they also need to understand how people work, think, and make decisions.”