The teaching of psychology and the new MCAT
In 2015 medical student applicants will be taking the new revised Medical College Admission Test (MCAT). The MCAT exam has been in use since 1928, and the current version (fourth revision) has not been modified since 1991. This high-stakes exam has been a major factor in determining an applicant’s readiness for medical school. The current changes in the revised MCAT exam reflect topical changes in medicine and changes in the perceived qualities of ideal physicians. In addition to the traditional areas of biology, physics and chemistry, questions will reflect newer areas of study such as cell and molecular biology, genetics, and genomics. What will be surprising to students and to more than a few premed advisors is an added emphasis on psychology, behavioral science, statistics, and research design.
The new MCAT will consist of four parts, assessing knowledge in (1) biological and biochemical foundations of living systems; (2) chemical and physical foundations of biological systems; (3) psychological, social, and biological foundations of behavior; and (4) critical analysis and reasoning skills. Psychology and behavioral science will receive as much attention as biology/biochemistry. These major test sections correspond to the knowledge and skill base that physicians need, and the best physicians will be the ones who can integrate each of these areas in their practice of medicine.
The preliminary work and input to the MCAT Revision Committee (MR5) was comprehensive and exhaustive. The diverse 21-member committee included vice presidents for academic health centers; medical school deans; admissions officers and educational affairs, student affairs, and diversity officers; basic and clinical sciences faculty; prehealth advisors and other baccalaureate faculty; a medical student; and two psychologists (a neuroscientist and a clinical psychologist). The diversity of committee members was meant to ensure that the new MCAT would be a valid, balanced and comprehensive test.
The information and data that drove the recommendations came not only from MR5 but also from undergraduate and medical school faculty, basic and clinical faculty, medical students, and residents. MR5 also considered input from other sources, including the Association of American Medical Colleges (AAMC)–Howard Hughes Medical Institute report on the Scientific Foundations for Future Physicians; the AAMC Be-havioral and Social Sciences Expert Panel; the AAMC Holistic Review Project; and the 2004 Institute of Medicine report, which recommend that behavioral and social science be enhanced in the medical school curriculum. All of this information was supplemented by data gained through 2,700 responses to a survey of medical students, residents, medical faculty, and administrators asking what they believed to be essential areas of medical education. Thus, there was an overwhelming amount of data and information supporting the new changes in the MCAT.
The new MCAT will measure critical analysis and reasoning skills. These are skills not unique to medicine, but are fundamental skills for many professionals and educated individuals. With knowledge increasing at a rapid rate, physicians will need to carefully evaluate new information and scientific data. How to think logically, rationally, empirically, and systematically about issues and problems will be among the skills that are measured in the examination. Passages that evaluate these skills will come from diverse offerings in ethics, scientific studies, cross-cultural studies, and the news/public media.
The focus of these MCAT changes has not been the accumulation of additional knowledge, but in contrast, the integration of all areas that influence health and illness-behavior. There has been a mistaken notion that the psychology/behavioral science part of MCAT will measure personality and psychopathology; however, psychological concepts such as altruism, cooperativeness, and extroversion will not be measured. This revised MCAT will measure knowledge and the integration of biology and social science.
The new MCAT will be a more comprehensive examination evaluating knowledge and skills across a diverse set of areas. It will be a historical change from previous MCAT exams, but hopefully it will be a better exam. It will not be sufficient to be well prepared in the natural and physical sciences only. The new MCAT will continue to be a major factor for students considering application to medical school. In its new structure, it will give admission committees additional input about the academic preparedness of potential students and about their abilities to consider their patients and the greater society more holistically. The challenges confronting present-day medicine will go far beyond conversations held in physician examination rooms, but will be addressed in the application of medicine in the community and society. In this context, ethics, public good and human values will be important variables to consider.
The importance of the inclusion of psychology and behavioral science on the MCAT cannot be minimized. Students who aspire to a career in medicine will be alerted to the fact that psychosocial/cultural issues matter and are as important as the biological and physical sciences because knowledge of the scientific aspects of psychology will need to be attained by premed students. Thus, the new MCAT may strengthen the level of scientific psychology instruction in many colleges and universities. Indirectly, the MCAT will help raise the awareness that psychological science is an embedded, essential aspect of health care.
Those of us in the psychology community can strive to ensure that future physicians get the needed background and input from our discipline. These are lofty goals but worthy of our best efforts and engagement.
Dr. Barry Hong has been a member of the 21-member MR5 Committee since 2008, representing clinical faculty members in medical schools. His membership on the committee is ongoing. He was the previous representative of the Association of Psychologists in Academic Health Centers (APAHC) to the Council of Academic Societies (CAS) of the AAMC and has served on various AAMC committees. Dr. Hong is professor of psychiatry, Internal Medicine and Psychology at the Washington University School of Medicine in St. Louis. He is also the chief psychologist for Barnes-Jewish Hospital.