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ScienceWeek
ON THE EVOLUTION OF MEDICAL SCHOOL ADMISSIONS TESTING
The following points are made by William C. McGaghie (J. Am. Med. Assoc. 2002 288:1085):
1) The origins of the Medical College Admission Test (MCAT) coincide with the rise of scientific psychology and quantitative approaches to mental measurement in the late 19th and early 20th centuries. The intellectual foundation of this work has been traced to ideas of Charles Darwin (1809-1882) expressed in his _On the Origin of Species_ (first published in 1859) concerning individual variation and natural selection. Sir Francis Galton (1822-1911), Darwin's cousin, subsequently attempted to measure human variation in intellectual abilities using a variety of laboratory tests. At the turn of the 20th century Alfred Binet (1857-1911) and Theodore Simon created early versions of intelligence tests, while E. L. Thorndike (1874-1949) developed several achievement tests and interpreted their results, in part, using the Karl Pearson (1857-1936) newly developed correlation coefficient. Early individual tests of intelligence and school achievement were quickly adapted for group administration in service of efficiency and extensive use.(1)
2) The technology of intelligence and achievement testing of school children was soon applied to other educational and social measurement problems. Psychological historian Murray Levine(1) observes: "It is likely that the experience in group testing in the schools before World War I prepared the way for the group intelligence tests developed by Army psychologists for the selection of officers and for screening out those who were intellectually inadequate for service. It was after the war that group tests came into wide use and became firmly entrenched in the schools and in our culture."
3) Scholastic aptitude has been defined as a fixed trait. Furthermore, there are individual differences in knowledge or skills that contribute to educational achievement. Scholastic aptitude emphasizes verbal, quantitative, and frequently subject-centered (eg, biology, chemistry, physics) knowledge and skill that enhance educational success. Operationally, academic aptitude is similar, if not identical, to common conceptions of intelligence. From their inception, intelligence, achievement, and aptitude tests have been judged by the extent to which, when given to a group, they yield a normal distribution of scores that clearly separates high, medium, and low performers. Reliable score differences allow for objective (scientific) norm-referenced selection, classification, or placement decisions about individuals.
4) In summary:
a) The attrition rate of 5% to 50% from US medical schools in the 1920s propelled the development of a test that would measure aptitude for medical studies. Since its development in 1928, the Medical College Admission Test (MCAT) has undergone 5 revisions.
b) The first version was divided into 6 to 8 subtests that focused on memory, knowledge of scientific terminology, reading and comprehension, and logic.
c) The second, which appeared in 1946, was reduced to 4 categories: verbal and quantitative skills, science knowledge, and added a category called understanding modern society.
d) The major difference in the third version, launched in 1962, expanded the test's understanding modern society section to a broader test of general information.
e) In 1977, the MCAT underwent its fourth change: its science section, reading and quantitative skill assessment sections were expanded; its general liberal arts knowledge section was eliminated; its scoring report structure and scoring range were altered; and its cultural and social bias was minimized.
f) The current version, beginning in 1991, has undergone another significant change. Although it does not contain independent measures of either liberal arts or numeracy as separate categories, quantitative skills are needed to solve some of the problems in biological and physical sciences. However, its principal innovation is the writing sample section.
g) Through its 74-year history, the various renditions of the MCAT demonstrate that the definition of aptitude for medical education reflects the professional and social mores and values of the time.
References (abridged):
1. Monroe WS. An Introduction to the Theory of Educational Measurements. Boston, Mass: Houghton Mifflin; 1923. Cited by: Levine M. The academic achievement test. Am Psychol. 1976;31:228-238.
2. Barzansky B, Etzel SI. Educational programs in US medical schools. JAMA. 2001;286:1049-1055.
3. Flexner A. Medical Education in the United States and Canada. New York, NY: Carnegie Foundation for the Advancement of Teaching; 1910. Bulletin No. 4.
4. Ludmerer KM. Learning to Heal. Baltimore, Md: Johns Hopkins University Press; 1985.
5. Scholastic Aptitude Test for Medical Schools, Form 15, First Edition. 1941; Hollinger Box No. 1; IM Box No. 501982734. Located at: Association of American Medical Colleges.
J. Am. Med. Assoc. http://www.jama.com
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Related Material:
EDUCATIONAL PROGRAMS IN US MEDICAL SCHOOLS, 2000-2001.
The following points are made by B. Barzansky and S.I. Etzel (J. Am. Med. Assoc. 2001 286:1075):
1) The authors report they used data from the 2000-2001 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and other sources to describe the status of medical education programs in the United States.
2) In 2000-2001, the number of full-time medical school faculty members was 103,553, a 1.1% increase from 1999-2000. The 37,092 applicants for the class entering in 2000 represented a 3.7% decrease from the number of applicants in 1999. The majority of medical schools (58%) were in the process of major curriculum review and change during 2000-2001. In 72 schools (58%), students were required to pass both Steps 1 and 2 of the United States Medical Licensing Examinations to advance or graduate.
3) The availability of patients to participate in clinical teaching during 2000-2001 decreased in almost half of schools compared with 1999-2000. Many schools reported difficulty in recruiting or retaining volunteer faculty members to provide clinical education in the community. Forty medical schools provided monetary payment to some or all community volunteer faculty members.
J. Am. Med. Assoc. http://www.jama.com
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Related Material:
OUR COMPACT WITH TOMORROW'S DOCTORS
The following points are made by J.J. Cohen (Acad Med 2002 77:475):
1) In recent years, the image of medicine as a caring profession has been badly tarnished by a rash of critical reports in the media. In the face of this negative publicity, do young people still want to be doctors? The author reviews conventional reasons given for the declining applicant pool (e.g., issues of declining income, loss of autonomy, etc.) and posits that an additional reason may be perceptions that doctors no longer command respect and that they are being oppressed by, rather than being guardians of, the health care system.
2) Such views challenge academic medicine to broadcast to the world a realistic picture of the fabulous opportunities and gratifications that lie ahead for the next generation of physicians. However, academic medicine must also address some current realities within medical education, such as the admission process (where at present there is a tendency to overemphasize indices of academic achievement and underemphasize the personal characteristics sought in applicants) and the acculturation process in medical school (which can often dehumanize students and convert idealistic ones into cynics).
3) The author acknowledges that these are tough challenges. He suggests as a first step that leaders of academic medicine prepare and disseminate an explicit statement of their commitments, a kind of compact between teachers and learners of medicine. He outlines these commitments, and states his hope that by fulfilling them, the academic medicine community can make clear that medicine -- which at its core is still about the doctor-patient relationship -- is a true calling, not just a beleaguered occupation.
Academic Medicine http://www.academicmedicine.org
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INFLUENCE OF MEDICAL SCHOOL APPLICANTS' DEMOGRAPHIC AND COGNITIVE CHARACTERISTICS ON INTERVIEWERS' RATINGS OF NONCOGNITIVE TRAITS.
The following points are made by D.L. Shaw et al (Acad Med 1995 70:532):
1) Interviews are commonly used to measure noncognitive traits of medical school applicants. The authors report a study that investigated the influence of knowledge of applicants' cognitive abilities on interviewers' ratings of noncognitive traits.
2) Academic and demographic predictors of interview ratings of applicants' noncognitive traits were examined at the Medical University of South Carolina College of Medicine during two years: 1992, when applicants' Medical College Admission Test (MCAT) total scores and undergraduate grade-point averages (GPAs) were available to interviewers; and 1993, when MCAT and GPA data were not available.
3) In 1992, 226 applicants met study criteria (i.e., they received ratings from three interviewers in addition to having MCAT and GPA data on file); in 1993, 245 applicants met the criteria. Step-wise regression analyses were conducted to measure the influences of seven independent variables on applicants' interview ratings. Two-way analyses of variances and t-tests were used to determine the effects of gender of applicants and interviewers. Cronbach's alpha coefficients were used as measures of interviewers' reliability.
4) Results: GPA was the best predictor for both years but accounted for double the amount of variance in interview ratings in 1992 (15.7%) compared with 1993 (7.4%). The reliability coefficients for the interviewers were 0.496 for 1992 and 0.473 for 1993.
5) The authors conclude: If the goal of the medical school admission interview is to assess noncognitive traits independently from academic skills, the authors recommend that MCAT and GPA data not be available to interviewers during interviews. The authors also found that gender and race influenced interview ratings in accordance with affirmative-action goals. Finally, the authors found that interview scores were only moderately reliable across different interviewers. They discuss ways to increase their reliability.
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