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A better MCAT may not produce better doctors

What does it take to become a good doctor? In the midst of a period of health care reform and primary care shortages, how we do to encourage talented students who want to give back to the community to go into medicine?

Since the 1920s, the Medical College Admissions Test, or MCAT, has played a central role in the admissions process for prospective medical students, helping admissions officers make tough calls about which students are best qualified to train as physicians. Initially developed as a way to reduce drop out and flunk out rates, the test now helps differentiate between applicants with near-perfect grades, college leadership positions and shadowing experience.

But the MCAT is due for a serious makeover. In 2015, the American Medical Association will be introducing a new version of the MCAT which, in addition to the chemistry, biology and physics questions on the current exam, will test material taught in introductory psychology, sociology and biochemistry. The purpose of the new emphasis on social and behavioral science, according to American Association of Medical Colleges (AAMC) President and CEO Dr. Darell G. Kirch, is that the AAMC is "recognizing in this test that being a good doctor is not just about understanding science, but it is also about understanding people."

At its core, the initiative to recruit broadly trained students shows insight into the more humanistic and less tangible aspects of medicine. But adding introductory psychology and sociology material to a standardized test is only one very specific way to assess an understanding of people. As a former Romance Languages major turned Political Science PhD student, I spent my college and graduate years reading and writing about the politics and economics of development in Latin America. I learned to discuss pain and poverty in Spanish, taught English to immigrants, and lived, taught, and backpacked on six different continents. But when I decided that I wanted to pursue medicine in my mid-20s, I had never taken a single psychology, sociology or biochemistry course.

I took on the challenge of starting the long medical career trajectory later than most students knowing that I could finish the pre-medical coursework in two years. Had I been required to take courses or pass an assessment in the additional subjects of psychology and sociology, it would have added another year and several thousand dollars more to my career path, and I probably would have given up on pursuing medicine before I started.

In this way, the new and more demanding format of the MCAT puts a particularly difficult burden on exactly the students that AAMC hopes to attract — those who have a broad range of interests and who spent their college careers, and perhaps a few years after college, pursuing subjects and hobbies about which they are passionate. Students who decided at an early age that they wanted to go to medical school and are using the college careers as a springboard for medicine will probably not be deterred by the additional requirements, and they'll plan accordingly to complete the longer list of requirements. But the students who worked in the Peace Corps or Teach for America and majored in music or language or even political science will be a few critical steps further away from careers in medicine.

The initiative to give more weight to social science training in the admissions process represents an important shift, and the AAMC should be credited for its insight into the social and humanistic skills that great doctors possess. But if the medical field is serious about recruiting students who understand people, we should be careful about how narrowly we define this understanding. Introductory sociology isn't the only place that students get perspective on the world; it's simply one of the easiest skills to measure. We need to make sure we don't discourage the next 26-year-old economics major who wants to leave a job in finance to train in health care and health policy.

Diane Kuhn received her PhD in political science from Harvard University and just completed her first year at Johns Hopkins Medical School. Her email is diane.kuhn@jhmi.edu.

Copyright © 2014, The Baltimore Sun
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