There’s more to being a physician than memorizing biology textbooks or knowing when to order a scan. Recognizing that a background in psychology and sociology is as critical to delivering effective, equitable health care as understanding biology, the AAMC rolled out a new MCAT® exam in 2015 to assess a medical school applicant’s knowledge about behavioral and social sciences. The Psychological, Social, and Biological Foundations of Behavior (PSBB) section was added to the MCAT with equal scoring weight to other portions of the exam.
“To be successful [as a physician] in this era requires mastery of core scientific principles in psychology and social sciences,” said Catherine Lucey, MD, vice dean for education at the University of California San Francisco (UCSF) School of Medicine and chair of the AAMC’s MCAT validity research committee. “There’s a science about how you help people change their behavior, how you manage to span cultural differences. There’s literature that tells us that one approach works better than the other.”
The PSBB section of the MCAT exam requires an understanding of cultural and social differences, social stratification and access to resources, and factors that influence communication and behavior. Admissions committees determine how their institutions will evaluate performance on the PSBB section of the MCAT exam, just as they do other admissions requirements. In partnership with the Robert Wood Johnson Foundation and Khan Academy, the AAMC developed free lessons covering content in PSBB and all other sections of the MCAT exam.
“To be successful [as a physician] in this era requires mastery of core scientific principles in psychology and social sciences.”
Catherine Lucey, MD
University of California San Francisco School of Medicine
The University of Illinois (UI) College of Medicine already requires applicants to have three semesters of undergraduate courses in subjects such as sociology and psychology. While most UI College of Medicine applicants are biological sciences majors, behavioral and social science majors made up 18 percent of the fall 2016 entering class, compared with 14 percent in 2015 and 2014 and 11 percent in 2013, noted Jorge Girotti, PhD, director of admissions for the college. “It seems to be an upward trend.”
Building the social sciences curriculum
A number of medical schools are adding more content related to social sciences to their curricula. In fall 2016, UCSF School of Medicine introduced the Bridges Curriculum. Social and behavioral sciences were once taught in small doses at UCSF but in Bridges, there are two month-long, first-year courses:
- Health and the Individual focuses on the experience of health and illness from the individual, family, and health professional perspectives.
- Health and Society explores the relationships between health and social policies surrounding housing, education, and health insurance, for example. This includes the physician’s role as a health care leader and advocate.
“What we really want to do as a medical system and a society is create health,” said Naomi Bardach, MD, associate professor of pediatrics and assistant director for the Health and Society course. “Ideally, the teaching that we do in these two blocks will be giving some kind of hope that it’s possible to help create health for people both one-on-one in the clinic and more broadly in society.”
Students have rotations in settings with marginalized, socially vulnerable patients—including individuals facing substance abuse, mental illness, immigrant status—or the elderly living in nursing homes. Such experiences help students build “cultural humility,” an awareness of how culture influences interactions and decision making, how certain factors contribute to bias and social justice inequities, and how government policies affect people from differing backgrounds. “Understanding the general principles of PSBB helps you be more ready for these advanced topics,” Lucey said.
At the University of Central Florida (UCF) College of Medicine which participated in the prototype PSBB research for the MCAT exam, students take two courses based in social sciences, Psychosocial Issues in Health Care and Brain and Behavior. Daniel Topping, MD, assistant professor of family medicine and anatomy, and director of the psychosocial issues course at UCF, said that although some students at first don’t consider those courses as important as, say, biochemistry, they later “come back with good feedback about how [the courses] helped them take care of patients.”
Impact of PSBB testing
It is not yet known if the PSBB section of the revised MCAT exam will significantly change the profile of medical school applicants or those in the accepted pool. Karen Mitchell, PhD, the AAMC’s senior director of admissions testing, said the PSBB section may help attract applicants from wider backgrounds. “It communicates the diversity of preparation and experience that medical school admissions committees are looking for when they select their classes.”
The AAMC’s MCAT validity research committee is continuing to explore the impact of the redesigned exam. An early study looked at the results of a prototype PSBB test administered in 2013 to first- and second-year students at 11 medical schools. The students’ academic performance was then tracked for two years. An analysis showed that students’ scores on the prototype PSBB predicted their medical school performance in behavioral and social science courses, such as foundations in behavioral health/psychiatric medicine, better than scores from the old MCAT exam.
For Jonathan D. Kibble, PhD, assistant dean of medical education and professor of physiology at UCF, the PSBB section of the MCAT exam “is very helpful for us to know what our incoming students may actually know about this material.”