The nation's top medical schools, responding to public demands for more compassionate physicians, are trying to attract more well-rounded students, a search that has spurred debate about what admissions criteria medical schools should use.
Educators interviewed recently agreed on the need to attract a new breed of medical students and said they are monitoring an unorthodox step toward that goal that was taken this year by Johns Hopkins School of Medicine.
Hopkins, one of the nation's most prestigious medical schools, has dropped its requirement that applicants take the Medical College Admissions Test (MCAT), a science exam that can make or break an undergraduate's plans for a career in medicine.
As a result, Hopkins' already large applicant pool has mushroomed, increasing 50 percent in just one year and drawing an unprecedented number of people in their thirties and forties with established careers in a wide variety of fields. It is too early to tell how many of these applicants will be admitted, Hopkins officials said, because acceptance letters are still being sent.
While Hopkins is only the second U.S. medical school to waive the MCAT requirement -- the University of Rochester did so in 1977 -- medical educators at other schools have expressed concern that the test encourages premedical students to focus too narrowly on science courses.
"The typical pre-med is described as a grind, a bookworm who's going to climb over everyone else to get where he's going," said Dr. Edwin W. Pullen, director of admissions at the University of Virginia's medical school, where the MCAT is still an important criterion for admission. "There is a concerted effort to make sure these people don't get into school -- into this school anyway. We're interested in as broad a person as we can get."
The University of Virginia and many other schools have made special efforts to attract medical school applicants who are humanities majors but have shown ability in science. At U-Va., according to Pullen, the admissions committee conducts in-depth interviews with applicants to weigh their character, motivation and ease with people.
Personal characteristics also are becoming increasingly important at Harvard University, according to its medical school admissions director, Dr. Gerald Foster. In an effort to attract well-rounded applicants, he said, the number of recommended undergraduate science courses has been reduced.
"Medical schools need to signal undergraduate schools and tell them not to focus obsessively on science," said Foster. Breadth of education is becoming more important, he said, as physicians are increasingly confronted with difficult ethical questions that have come with advances in technology.
William Koehler, a 34-year-old former English teacher enrolled in a post-baccalaureate premedical program at Bryn Mawr College in Pennsylvania, said he believes his maturity and life experience will make him effective with patients.
"I think I'll see people in a more . . . holistic way," he said. Koehler said he believes that the rising number of medical malpractice suits is more a reflection of poor doctor-patient relationships than of quality of medical care.
Hopkins officials said that among the 3,800 applicants for 120 spots in this fall's first-year class are nurses, science teachers, health care administrators, Peace Corps volunteers, business persons, lawyers and a large contingent of bureaucrats from the U.S. Environmental Protection Agency and Food and Drug Administration.
"Some have done very striking things in their careers," said Dean of Admissions Norman D. Anderson. "We would argue strongly that they can make a substantial contribution to the field of medicine."
Anderson said Hopkins made the test optional in part to help reduce the fixation on scores and grade-point averages among premedical students. "They become very competitive," he said. "They construct a facade of competence in science so they can get into medical school."
While Anderson said he has talked to officials at other medical schools about dropping the MCAT requirement and expects some of them to do so, admissions officials at several leading medical schools, including some in this area, said they have no plans to follow suit.
Karen Pfordresher, director of medical school admissions at Georgetown University, said officials there consider the MCAT a valid and necessary tool for determining whether a student is likely to do well in medical school. "The classes have been diverse to the extent the applicant pool has been diverse," she said, adding that Georgetown receives more than 6,000 applications for 205 spots.
The University of Maryland also has no plans to make the MCAT optional. But Vice Dean Marjorie Wilson noted, "We're watching Hopkins with considerable interest."
The University of Virginia's Pullen, who is reviewing 2,800 applications for a fall class of 139, said the admissions committee has discussed the Hopkins action and is strongly in favor of retaining the MCAT requirement.
"We feel we need a test as an instrument to give us an objective evaluation of cognitive ability and general aptitude," said Pullen.
Hopkins continues to require some form of standardized measure of ability or knowledge, either scores from the high school Scholastic Aptitude Test or the Graduate Record Exam. In addition, applicants must have a minimum of four core undergraduate science courses, including physics and organic chemistry.
Although taking the test is optional, Hopkins insists on seeing MCAT scores for students who choose to take it. A majority of this year's applicants submitted MCAT scores, according to Anderson, because they had to take the test in order to apply to other schools.
Although Georgetown and U-Va., like Hopkins, attract many more highly qualified applicants than they can accept, educators said a shrinking applicant pool nationwide could force lesser-known medical schools to consider waiving the MCAT or changing admissions requirements to draw more applicants. In the past few years, the number of applicants has dropped from nearly three for every available place in medical school to fewer than two.
Concern about the MCAT and the pressure it puts on students to immerse themselves in science at the exclusion of other interests has registered with the Association of American Medical Colleges, the organization that sponsors the test. Association officials said the test is going to be changed to lessen the emphasis on knowledge of science.
Currently, the MCAT is divided into six sections -- physics, biology, chemistry, science problems, reading and math.
Dr. August G. Swanson, director of academic affairs for the association, said a general essay question may be added to the MCAT and several of the science categories may be merged.
"I think the essay is going to send a loud message that the ability to think and express thoughts is a very important part of being a physician," Swanson said. "It would suggest they [premedical students] should have the full balance of educational skills that colleges are supposed to provide them."
Swanson said that by placing so much value on the test scores, some medical schools contribute to the pressure on students to use their undergraduate years to cram for the MCAT.
Swanson, who has looked closely at the medical students Hopkins has admitted this year, disputes the admissions office's claim that the optional MCAT will change the profile of the student body. Swanson said Hopkins appears to be as concerned with grades as premedical students themselves. He noted that 50 percent of those accepted last year had grade-point averages of 3.8 or better in their science courses.
He said that while the applicant pool at Hopkins may be more diverse, the number of older students and liberal arts majors accepted so far for this fall's class is no greater than in past years and is comparable to the number of those types of students admitted to other medical schools.
"No matter who you invite to apply," he said, "it doesn't make much difference unless you're prepared to alter your [acceptance] criteria."