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Opinion Med schools should de-emphasize standardized admissions tests

Students and faculty walk through an open area outside the School of Medicine on the campus of the University of North Carolina at Chapel Hill on Aug. 18, 2020. (Melissa Sue Gerrits/Getty Images)
5 min

Alessandro Hammond is a student at Harvard University and a researcher in oncology and hematology at Boston Children’s Hospital. Cameron Sabet is a University of Pennsylvania graduate student studying religious studies and medical ethics.

The American Bar Association recently announced that, to remove barriers to entry to disadvantaged students, it will drop the LSAT as a requirement for future law school applicants. Now it’s time for medical schools to take a similar step, for a similar reason, and rethink their dependence on the Medical College Admission Test, or MCAT.

The American Association of Medical Colleges (AAMC) currently mandates that medical school admissions teams include the MCAT score among the many variables they use in evaluating applicants. Proponents tout the test as the great equalizer of applicant competency assessments — leveling the playing field for students who come from varying academic backgrounds and testing their basic scientific knowledge.

However, like the LSAT, and the SAT for college admissions, the MCAT clearly favors White applicants who have the wealth and resources to help them achieve competitive scores on the test — and disadvantages those from a lower socioeconomic background. Well-to-do applicants can gain an edge through books, courses and coaches — and even by retaking the test, which is one of the most expensive standardized tests, at a fee of $330 (as opposed to $215 for the LSAT and $60 for the SAT), multiple times to keep improving their score.

Seats at the top medical schools often require 99th percentile scores, though the median MCAT score for White med school matriculants is the 83rd percentile (512.6). For Black matriculants, meanwhile, it is the 61st percentile (505.7); for Hispanics, the 65th percentile (506.1); and for American Indians or Alaska Natives, the 58th percentile (504.9). Looking at these figures, it’s clear that medical schools understand that minority students meet some threshold of competency even if they achieve lower scores. It’s time to codify this tacit acknowledgment that these racial differences in scores reflect meaningless socioeconomic privileges that do not define candidate worthiness. We don’t propose eliminating the test, as it does measure core competencies — organic chemistry, general chemistry, biology, etc. — required for medical school. But the AAMC should make the MCAT a pass/fail exam to remove barriers for disadvantaged minority applicants, while still ensuring that students are prepared for medical school.

This is a crucial step if the medical profession is to diversify its physician ranks and develop trust among underserved minority communities. Given the history of academic medicine’s exploitation of Black patients for research and eugenics purposes, this distrust is not entirely misplaced. Even today, Black patients generally fare worse than White patients. A Stanford University study revealed that Black patients have better health outcomes when paired with physicians of the same race, and that Black physicians take more detailed notes on Black patients than their White counterparts. African Americans are twice as likely to trust information provided by someone of their own race. This trust relationship affects overall population trust in medicine: A poll taken in the first year of the covid-19 pandemic, for instance, showed that only 14 percent of Blacks and 34 percent of Latinx respondents trusted the mRNA vaccines.

Through a more equitable medical school admissions process, we can tackle these downstream demographic deficiencies in our physician workforce. Currently, Black physicians, for instance, constitute only 5 percent of that workforce. This percentage has remained stable since the 1970s, but it need not continue that way. In fact, the proportion of Black matriculants to medical school rose between the 2020-21 and 2021-22 admissions cycles, a result of historically Black colleges and universities’ efforts to improve Black representation in health care. HBCUs acknowledge that MCAT scores do not tell the full story of an applicant, and have been implementing solutions for more holistic evaluations of candidacy. For example, the Howard University College of Medicine has an unconscious bias training course for interviewers and blinds MCAT scores and college GPA — two of the most important metrics used in the pre-interview screening process — until after an applicant’s interview.

A 2015 study determined that there is little correlation, if any, between the MCAT and performance in medical school and beyond. Since the MCAT does not accurately predict clinical excellence and is not a determinant of candidate quality, the AAMC should recognize that this standardized exam is an indeterminate predictor of success. As British economist Charles Goodhart famously noted in a 1975 publication, once a metric becomes a target, it is no longer a good measure.

Most importantly, numerical metrics do not test for the traits patients look for in their ideal physician: As a 2006 Mayo Clinic study of 192 patients revealed, empathy, forthrightness and respect are among the qualities patients most desire in their doctors. In their admissions policy, medical schools should put greater emphasis on interviews, essays, and increasingly recommended or required personality tests such as Casper or the AAMC Situational Judgment Test, which highlight the crucial traits of a successful physician better than the MCAT.

Unless the AAMC acts now to eliminate graded standardized testing requirements, the medical community will continue to grapple with the challenges of building trust in minority communities.