Keeping the Test a Test

Many aspiring doctors probably think the undergraduate pre-med track is demanding enough as is. In a recent report, however, a committee of the Association of American Medical Colleges recommended significant changes to the much-dreaded Medical College Admission Test. Aside from adding an extra 90 minutes to the already five-and-a-half-hour MCAT, the AAMC plans on dividing the test into four sections—two of which will consist of “behavioral and social sciences” and “critical analysis and reasoning.”

The AAMC’s report explained that the changes are designed to draw greater attention to certain concepts in medicine, including a greater focus on “cultural and social sensitivity.” Although the report does not volunteer a precise meaning of this last phrase, it seems safe to guess that people skills—anything ranging from bedside manner to multicultural awareness—will soon feature on the revised MCAT, which will come into place in 2015. The decision to test the cultural and social skills of aspiring undergraduate doctors is intriguing. Of course, effective doctors should exhibit first-rate people skills, and, for patients, there are few parts of a hospital experience as dispiriting as an abrasive doctor.

In that sense, this aspect of the MCAT’s new requirements can only be a positive addition. If the ultimate AAMC’s ultimate goal, however, is to produce a generation of culturally sensitive doctors, its decision to test this quality as a prerequisite for medical school admission makes less sense. The MCAT, grueling enough as it is, has worked in the past by examining whether students are academically prepared to study to be a doctor.  The point of this exam should be to gauge aptitude and potential, not whether students are already fully trained doctors before starting medical school.

Like any other exam, the MCAT’s ability to test people skills can ultimately only be as effective as trying to decide whether an applicant is a nice person without ever meeting them. To examine a student’s knowledge of biochemistry is one thing, but to test out someone’s ability to relate to a patient is another. In all likelihood, students—in a twist of irony—will be forced to prepare for this aspect of the new test just as they study for the rest of the MCAT: by memorizing material and practicing cultural sensitivity questions, whatever those may be.

Undergraduates may learn something in the process, but it is doubtful whether this kind of method can accurately test real personal and social skills. To give a flavor of what’s likely to come, Amjed Saffarini, executive director of pre-health programs at Kaplan Test Prep, said that the new requirements would result in possibly the biggest changes ever to the MCAT’s curriculum. It is not hard to imagine a new “cultural and social skills” chapter in Kaplan’s revised guide to the exam. Like the standardized test for College entry, the AAMC will extend the MCAT into a test of the supposedly un-learnable, and, in doing so, transform medical social skills into the latest discipline of exam studying. But in that this kind of learning may force students to memorize details, it may not necessarily produce the desired effect. In fact, if different cultural attitudes to medicine are to be quickly regurgitated on the exam, one has to wonder about the potential for cultural stereotyping.

This particular addition will also contribute to the increased time of an already very long exam. With this in mind, the benefit of examining personal skills seems even more unlikely to outweigh the cost to a student’s performance and the ability to assess this accurately.

It seems ironic that with the host of requirements many pre-med students must already fulfill to apply for medical school, the AAMC has decided that cultural sensitivity must be tested earlier on. Focused on taking the courses, doing medical work over the summer, and meeting an exacting GPA cut-off, many students never have the time to pursue divergent extra-curricular interests, let alone go abroad for a semester.  If anything, allowing more flexibility in pre-med requirements will do more to promote cultural awareness and people skills than a mere alteration to an exam.