Dan Diamond
Americans want a lot from our doctors.
We want caring bedside manner, effective communication, up-to-date knowledge, and finely honed clinical skills. We ideally want more than five minutes to spare in a visit.
We want doctors who treat the whole person, not just the illness; doctors who can stay attentive despite the obstacles the system throws at them. (Recent data show that “customer service” and communication skills contribute most to patients’ satisfaction, with clinical skills in close third place.)
Clearly, medical knowledge isn’t the only thing that matters to patients — yet clinical mastery is enough to get a student through medical school.
So if we want more from our doctors, why don’t we ask it of our medical students?
As students ourselves, we would know: There’s been a major gap in our education. And it started with the Medical College Admissions Test.
Just a few years ago, like tens of thousands of hopeful doctors, we took the MCAT. Before medical school, MCAT test day was the most important day of our careers—only 40% of applicants are admitted to any U.S. medical school in a year, so admissions committees heavily rely on a student’s MCAT score when making their decisions.
And the years we spent preparing for the MCAT gauntlet have stayed with us: They shaped how we see science, how we prepare for tests, and most importantly, how we think about medicine.
But the MCAT changed this month. And the new version of the test gives us—and it should give you, as a potential patient—a lot to be excited about.
What the new MCAT looks like
Here’s what’s stayed the same about the MCAT: The test has kept its section on biological sciences and its section on physical sciences, too.
Here’s what’s changed:
- The new MCAT adds a section covering introductory psychology, sociology, and neuroscience.
- It replaced its old section on “verbal reasoning” with a broader test of comprehension in the humanities and social sciences.
- It eliminated the essay.
The MCAT 2015 also has a new emphasis on research, including designing studies and analyzing their results.
Why make these changes?
The Association of American Medical Colleges (AAMC), which administers the test, correctly contends that “tomorrow’s physicians need broader skills and knowledge than in the past.”
If you’ve ever spent time around a modern hospital, which demands empathetic communication, tech savvy, and the ability to respond to a rapidly changing body of knowledge, you probably agree with the AAMC. We certainly do.
Both of us majored in the humanities and social sciences as undergrads, which frames how we see our own patients. We’ve seen the power of statistics in our own research.
Most of all, spending time outside medicine — in business, service, and other fields — has shown us the world beyond science, the world that most of our patients inhabit. We hope the new MCAT fosters more medical students who’ve explored more of the world beyond the classroom; it will only make them better able to connect and care for patients.
Finally, this revision sends an important message. The current premedical curriculum only adds to the prevailing attitude that success in the “hard sciences” (biology, chemistry, organic chemistry, and physics) is all that determines success in medicine, and that the social determinants of health are “soft” in comparison.
But if you’ve ever had a doctor who can choose an affordable treatment based on your insurance status, or who understands that there’s more to your life than your disease, you may agree that those skills aren’t soft — they’re critical.
That’s why we applaud the AAMC for resisting this bias and placing social science, psychology, and the humanities on the same plane as pure science — where they belong. The new MCAT sends a new signal to aspiring docs: they need this knowledge just as much as they need hard science, and the medical community now demands they have it.
What’s still missing
Now comes the hard part.
History shows a new test alone won’t change medicine. From 1946 to 1977, the MCAT had a “general knowledge” section focused on history, economics, government, and sociology. Although that version of the test rewarded broad knowledge, admissions committees did not; they continued to focus on the “hard science” exposure in students’ applications. In fact, the general knowledge section was eliminated in part because it was “not considered to be of major importance.”
As Dr. George Miller, a physician and scholar of medical education, observed fifty years ago, this was a sad irony — medical school catalogues exhorted applicants to seek out a broad, “liberal” education, but medical school admissions committees mostly ignored it.
Times have changed, of course. But unless admissions committees firmly commit to selecting “broader” applicants in all aspects of their applications, the newest version of the MCAT will fail in the same way its ancestor did.
If something doesn’t matter to admissions committees, it might as well not exist to most premeds.
We shape years of our lives around what might stand out: undergraduate courses, extracurricular activities, jobs, and more. We shaped ourselves in ways that will affect what types of clinicians we become.
So the ultimate test of the new MCAT isn’t how it influences pre-med students’ behavior. (Especially because a test can only say so much about future behavior and character.)
Instead, the next step is on admissions committees.
If they are truly interested in the MCAT’s new topics, they should reward applicants who’ve shown action in these realms, whether through innovative interview models or a broader lens for evaluating student experiences. This approach, more than any other change, would create a sea change in applicants’ attitudes and experiences.
Of course, if it’s on a test, students will learn it. We know that quite well — otherwise we wouldn’t have made it into medical school.
So we have little doubt that the new MCAT will encourage students to study more about the humanities, social and brain sciences, and determinants of health. But the change we need for a new crop of doctors requires more than reshuffling the questions on a test.
It requires our profession’s gatekeepers to change, too.