Wanted: Fewer science nerds, more 'culturally competent' doctors

The test that all medical school applicants take  could place greater emphasis on behavioral and social sciences, adding a new component and lengthening the test to seven hours, if proposed changes are accepted.

Members of the committee that proposed the changes to the Medical College Admission Test (MCAT) say that this could help better identify applicants who have a greater understanding of behavioral and social factors that contribute to health problems.

“We want to broaden the knowledge base that students have about those factors that influence health,” said committee chair Dr. Steven Gabbe, who is also CEO of the Ohio State University Medical Center. “Yes, you must have solid base in science, but you have to understand the challenges.  You have to be culturally competent to understand socio-economic challenges in different groups face dealing with health problems.”The more a physician realizes social factors , the more it could help him or her understand health consequences, medical school officials said.

Of the MCAT’s four sections, two would remain strictly science, assessing how well the test taker solves problems about molecular, cellular properties as well as the physical, chemical, and biochemical properties of living systems.

The proposed changes require approval from the American Association of Medical Colleges' board of directors in February 2012.  If approved, the new exams would begin in 2015.

Here are the committee’s main recommendations:

- Update the exam’s two natural sciences sections to reflect current science and test how examinees solve problems in a way that helps demonstrate their scientific thinking and research skills.  The scientific content would include more current scientific knowledge, incorporating biochemistry and cellular molecular biology.

- Revise the current verbal section to assess the way test takers reason through passages. Test takers will have to read passages pertaining to health and could include cultural literacy, ethics, philosophy and population health.

The current writing section would be eliminated, under the new proposals.

- Add a new test section on the behavioral and social sciences concepts that lay the foundation for medical students’ learning about the human and social issues of medicine. The test would cover content covered in intro to sociology and psychology classes, which many students already take as requirements at their schools, said Karen Mitchell, MCAT director.

This portion would also be multiple-choice and test for competency in understanding ideas, such as behavioral changes, environmental factors on health, cultural differences and inequities, and how demographics or cultural socio-economic differences influence resources and well-being.

“What they learn in medical school are the ways social factors and behavior relate to health,” she said.  “What medical faculty want them to know is something about individual behavior, group behavior, culture, motivation, sensory -  that they come in with the basic vocabulary and understanding of the foundational knowledge.”

These proposals came after three years of outreach events and surveys, the gathering of advisory groups' opinions and more than 2,700 responses from students, staff, administrators and medical residents.

“That kind of input caused us to say, we need to at least test some of the principles of sociology, psychology, statistics, so that students are preparing to be physicians and taking the coursework required to be that knowledgeable,” said Ronald D. Franks, M.D., vice-chair of the committee and vice president of health sciences at the University of South Alabama.  “The purpose of the test helps identify those applicants who would be well-prepared of dealing with those aspects.”

This also pertains to diversity.

“It speaks to an awareness of cultures outside of the one they grew up in,” he said.  “We’re going to be more sensitive to those issues.”

Robert Schaeffer, public education director of the National Center for Fair & Open Testing and frequent critic of standardized exams, said the proposals are headed in the right direction.

“Medical schools’ leadership, as reflected by AAMC, is indeed trying to change the types of students who are recruited for medical schools to emphasize more diversity of all sorts,” he said.  “There is a growing perception because of the emphasis of MCAT in medical school admissions, you’re getting science nerds - kids who are strong at mastering scientific facts, but are not so strong at dealing with patients, real human beings with real human problems, which have to be dealt with a broader array of disposition.”

“The kind of diversity they’re looking for are intellectual, cultural, racial.”

As statistics indicate, students from lower economic backgrounds tend to score lower on MCATs, which are crucial in determining medical school admissions.

Of nearly 80,000 medical students in the U.S, about 7% are African American and 8% are of Hispanic descent in a country that is increasingly more diverse. Asians and whites comprise nearly 80 percent.

Pre-medical students are not fretting about the possible changes yet.

"For students, this is not on their radar," said Paul Crosby, a pre-medical advisor at University of Kansas since 1996. "Advisers are starting to discuss it to some extent. The recommendations are fairly general. It's hard to react without knowing specifically how it would play out."