Hurray, the new MCAT is here!!!

In My Humble Opinion
1

The first major revision of the Medical College Admission Test in 25 years has been announced, and it promises to be a wonderful new experience and aid in selecting the Doctors of the Future.

The number of questions is up from 144 to 230 and exam time increased from a little over 4 hours to about 7 1/2 hours. The key though is less emphasis on science and more on sociology.

*“One hundred years ago, all you really needed to know was the science”…said (UCSF vice dean) Catherine Lucey…“Now we have problems like obesity and diabetes that require doctors to form therapeutic alliances with patients and convince them to change their lifestyle.”

To that end, a large new section - one quarter of the test - covers psychology, sociology and biological foundations of behavior. Official review material includes concepts such as social inequality, class consciousness, racial and ethnic identity, “institutionalized racism and discrimination” and “power, privilege and prestige.”*

It’ll be such a relief when these new docs hit the streets. No longer will I have to endure physicians who merely do exams, order tests and fill prescriptions for drugs. Emphasis on this traditional crap will be lessened, as they counsel patients on lifestyle changes (no physician ever did this before), and more importantly, recognize the institutionalized racism and power structure abuses that lead to angina, pneumonia and hemorrhoids. To make things easier, I can envision a set of questions they will pull up on their laptops, which must be answered and an online form completed before federal reimbursement can be considered.

A brave new world is coming…:slight_smile:

2

Tell me about it . . .

When are you retiring?

I figure I can afford to get out in about 5 years. Can’t wait.

I love my time with patients, but having to address everything AND document it, all in 4.5minutes per patient makes it not much fun. AND I’m already in the last bastion of a traditional medical practice where my worth is not judged by my productivity and ability to integrate with their homeopathist and chiropractor.

Viva the new MCAT!

3

I mean this out of curiosity, though I imagine it might be raining on your parade, but is there any evidence that doctors can change a patient’s lifestyle via forming a bond and giving them a periodic lessoning?

4

Isn’t that how homeopathy works?

5

No. Homeopathy is just taking advantage of the placebo effect.

The difference between adding a pill to your daily routine or cutting your caloric intake by 50% are vastly different levels of difficulty apart.

6

I don’t want to form a “therapeutic bond” with my doctor, I just want the drugs. :slight_smile:

None of this glop is likely to have much effect on my own practice. I am not looking forward to going to a new physician and having a yard-long questionnaire to fill out, specifying my position in the power structure, ethnic history* and the biologic foundations of my behaviors.

*oddly, I can well recall during my own training back in the Pleistocene era, learning about predispositions toward certain diseases in various ethnic groups, although we did not have to study up on cultural interactions with the physician before taking the MCAT.

7

I would assume that there is science and statistical analysis behind the updates. What is the reasoning behind the changes? At first blush, you guys just seem like dinosaurs complaining about the newfangled things and are having a knee jerk resistence to change.

Since I’m not a doctor, you can tell me what an ignorant asshat I am for saying this, and I’ll accept the abuse without complaining.

8

Change that improves care of patients is welcome. I for one would like to see considerably less rote memorization in medical school (do aspiring docs really need to learn minute details of anatomy and esoteric biochemical reactions which will almost immediately be forgotten?) in favor of skills that will help evaluate and treat patients. I do not see that de-emphasizing science in favor of “class consciousness” will achieve this end. There are only so many hours in the day, and adding non-essential components to training inevitably means shortchanging other areas.

Wrong forum. :slight_smile:

9

Well given that those were what the old MCAT emphasized, maybe you don’t mourn its death too badly?

Someone needs to argue the other side here …

The old MCAT way preferentially selected for those who were most interested and most proficient at memorizing all the mundane details of the Kreb’s cycle and that ilk. True that we need a solid cadre of hard science folks in medicine but there is zero reason to believe that excelling at memorizing the Kreb’s cycle and all the epicycles around it has any correlation with the ability to get a good history, to do a good physical exam, to be good at the pattern recognition that is every clinical encounter, to make good clinical judgements, to work as part of a healthcare team coordinating care (yes that IS how medicine works now), and to sell patients on behaviors that matter.

Maybe a test that still requires proving that a candidate has adequate mastery of the hard sciences but does not exclusively select for that mastery will do a bit better?

Given even the current of we dinosaurs can actually be somewhat effective in motivating change … maybe having some docs who did more than hard science could do even better?

Realistically we not only do not need to, none of us realistically could possibly, master the hard sciences that are the foundations of medicine today. Pretending that we do as we add more and more into the mix without ever taking anything away is silly. We need to be able to critically evaluate information. We need to be able to get and evaluate a history well. We need to have puzzle solving skills and good pattern recognition, recognizing when something does not fit as much as what it is. We need to be able to adapt to the fact that healthcare delivery is now a team sport that is as concerned with taking care of complete populations as it is individuals. We do not need to be chemists or physicists, at least not all of us.

Maybe a few sociology and anthropology majors could actually be of more use.

Anyway one of my boys is taking it this year, so wish him luck!

10

I hate it when they dumb down tests, absolutely hate it. And if they are going to dumb down a test anywhere, it should surely not be one for physicians. I want the smartest doctor I can find if something is wrong with me.

But if I’m to be absolutely fair, I wouldn’t mind having a Dr. Welby on staff, too, along with a Dr. House. Dr. House can figure out what esoteric thing is wrong with me and cure me, while Dr. Welby can help me feel better about it.

11

I’m just a Doper, who is curious about the scientific underpinning of the change.

12

Maybe I have blanked it out, but I don’t remember having to regurgitate the Krebs’ cycle on the MCAT, not to mention the hundreds of other biochemical reactions we had to learn in med school*, nor details of human gross anatomy. Some basic science and math certainly (I also (thankfully) took it in the pre-essay days.

I with you on the above skills, with excellent critical thinking skills possibly being the most essential to a good physician.

I don’t buy that a good med school candidate must be either “a chemist or physicist” or an ideologue who has a good line of rants about the Power Structure, institutionalized racism etc.

As I mentioned earlier, I don’t support the type of rote memorization in the basic sciences that was prevalent in my med school days, and I welcome change that promises to produce better physicians. I also don’t think the profession (or patients) will be better off if it’s geared less towards preventing and healing disease and more as a vehicle for some people’s desires for social change. Although I doubt the new MCAT will result in radical change. Mostly, it’ll be a new set of hoops for med school candidates to jump through.

*I remember a long, complex chart that hung on the door of one of my biochem professors, detailing myriad biochemical reactions and how they fed into each other. Incredibly, at one time I knew virtually all of them by heart. As of now, I retain at best .000002% of that information.

13

This is not a dumbed down test. It is testing the science to pretty much the same degree as they ever did but have added some other sections - they’ve added the material that would be covered in an intro psychology class and and intro sociology class. Looking it up there is more biochem (NOOOOO!) More on research design and data analysis. It’s about twice as long.

Yeah, it was a long time ago. Kreb’s probably wasn’t on it. But as one review put it “calculating the magnetic force acting on a wire, or how they would synthesize a polysubstituted aromatic compound from a 3-carbon or less alkyl halide” was (and apparently still is). The point is that who it selected for were the people good at memorizing those formulae and facts.

That said I don’t know how you’d design a test to weed the bookcases out from the scholars.

No, I don’t think one has to be either a hard scientist or a sociologist to be a doctor either, but I think there is room for both. Organic chemistry and physics have little to do with the practice of medicine. What having mastered those subjects does is prove that you can learn that sort of material (and my personal experience is that organic teaches an approach to problem solving that translates to other areas). The same can be said for demonstrating that you can master the basics of an intro psych and sociology class. And the new bits on research design and data analysis are likely good additions. Although “quality” will be defined by following the protocol no matter what you think of the literature that supports it …

Yes it is no more and no less than a different set of hoops but what hoops you set out determine who is more likely selected. This choice says that we want do not want to only select those who can memorize hard science facts; we want a wider pool, a broader exposure to other subjects.

Yes I also could close my eyes and visualize that whole damn poster and write it all out tracking the damn carbon along. I still shiver.

I remember a professor on the first day of medical school stating that “Half of what you learn these next four years will be proven wrong in a decade; you will forget half of what you learn. Please try to make them the same half.”

14

So we want a pool of applicants who can memorize buzzwords/buzz-concepts about “institutionalized racism” and the Power Elite? :dubious::smack:

For an ideal exam, I’d hope there would be questions to test critical thinking capacity and knowledge of logical fallacies. However, that might conflict with current trends in academic medicine (i.e. “integrating” woo into evidence-based medicine, which the esteemed Orac has likened to mixing cow flops into apple pie - you wind up not with the presumed “best of both worlds”, but with a crappy-tasting pie).

15

You know, when I hear about childbirth in my mother’s day (just a few decades ago!) it sounds positively barbaric. Women tied down, drugged up, isolated from their spouses, discouraged from breast feeding, immediately separated from their new baby (but they could peer through the window into the nursery)…I’m sorry, but compared to my giving birth (hospital birth, nice room, baby in my arms immediately and sleeping in a bassinet by my side, a bed for daddy, my choice of drugs, lactation nurse visiting regularly, back home ASAP…) it sounds like a freaking horror story. It’s hard to believe anyone felt like that version of things was okay ever, much less in modern America.

Medicine has come an enormous way in understanding how to help patients understand what’s happening, understand the choices and trade-offs that come with different treatments (like, say, a radical mastectomy versus a treatment that preserves more, or the trade offs between quality and quantity when treating terminal illnesses.)

Medicine has come a long ways when understanding how different people are likely to prefer or be compliment with different treatments. If you haven’t read the now-classic “The Spirit Catches you and you Fall Down”, do so. Basically a team of doctors took an aggressive approach to treating a Hmong toddler with epilepsy. They did not account for the illiterate parent’s inability to comply with complex treatment regimes that require precise doses at precise times, completely different understanding of what epilepsy actually is, and preference for traditional medicine. If the doctors had been able to work within the parent’s understanding, and used an existing and much simpler treatment while framing the issues in ways they would understand, it would have had a much better outcome.

On the other side of the coin, for a while public health organizations took to recommending giving people with TB in developing countries a second-line treatment. It was much cheaper and easier to manage. It was also much less effective, and now we have a massive global drug-resistant TB problem. An aggressive approach using the best medicine would have saved a lot of lives and a LOT of money.

We have come a long way even in just the past decade. But this is just the start. And I am glad medical schools are taking on these challenges, rather than focusing on memorization that frankly computers are going to be doing for us soon anyway

16

Do you really think that such is all that is taught in basic sociology and psychology classes and all that is being tested?

If so I invite you to look at the actual MCAT “concept map” and in particular the pertinent sections 6 through 10. Yes, in addition to basic perception, cognitive processes, emotional processes, stress and its impact, personality theories, the interactions of genetics and environmental influences on behavioral outcomes, social norms and their impact, models of how attitudes and behaviors change including the elaboration likelihood model and social cognitive theory, identity formation and developmental theories, the psychology of stereotype formation, group dynamics and the formation of cultures, and the concepts of demographic shifts, they also test on concepts related to “spatial inequality, the structure and patterns of social class, and health disparities in relation to class, race/ethnicity, and gender.”

Yes, in today’s medical world you are better off understanding what the buzzwords mean and what the concepts are that they represent. Yes, the age of being as concerned about health of populations as a whole, in addition to the health of the individual in front of you, is here. Yes, I do believe that understanding something about the individual psychology, the psychology of populations, and the potential barriers to efficient care delivery is going to be increasingly important in achieving better population-wide outcomes, preferably at cheaper total costs. Even if it means learning about “buzzwords” like “institutional racism” … which buzzword or not is a real thing with real healthcare impacts.

Personally, I think that those concepts may be more important for the next generation of physicians to understand than testing them on Hooke’s Law or what shape and how many electrons fill up p-orbitals. (Dumbell and 3, right? If so it is taking up space that I need for other information goddamnit!) As much as I really did like physics and have a deep affection for the puzzle process of organic chem.

We did not get trained in thinking much about population groups as the patients but that is increasingly and important level of care analysis. If only for sheer self-interest we need to become good at that because the new payment order ties reimbursement to population wide outcome and value metrics. These concepts are the physiology of group processes. Powers that be will be deciding things using those concepts as well and we need to know the language.

Like it or not it is not the future; it is the now.

17

Whoa, hey now slow down, that’s going a bit too far:)

18

I’d bet most people going to the doctor want someone who is focused on their health, rather than being distracted by the need to collect a bunch of demographic information to complete mandated forms. And if polled, I suspect they’d want a physician whose education and training maximizes knowledge and expertise directly translatable into achieving the best possible health outcome for them.

Oh, I have no doubt this will be the case. And it will all have to be documented by physicians inputting data into their laptops, even as what the patients are saying dissolves into a drone in a background.

19

No, there is evidence that having a doctor-patient bond can help (less white-coat effect, lower likelihood of forgetting key information, less outright lying to the doctor), but sadly it’s being treated like the information that people like having a personal relationship with their retailer. clink clink “have a nice day, Mistress Naffa!”

20

Sorry but your leap from learning about how to impact health at the level of populations to collecting a bunch of demographic information and mandated forms is quite a big one.

The impact of our understanding these issues is less in the room* than how we organize and utilize our systems, assuming that you want physicians to be major players in organizing the systems rather than leaving it all to the MBAs.**

It means the physician is as focused as ever on the patient in the room’s health but the system that they are leaders in is also identifying which subsets of the population is most likely to end up in Emergency Room or get re-admitted and to pre-empt those costly (both in dollars and in quality of life) events by addressing the barriers to adequate follow up and even bring extra resources to bear with higher intensity outreach to those at higher risk. Even patients who have never yet shown up in our offices but are still our responsibility. We use our system to reach them. The system they are leaders in is working to educate the communities they serve on preventative care and making it easy for parents and grandparents to get influenza and TDaP vaccines while at the kids’ visits and by understanding how populations work able to get more vaccinated. It is able to address the issue that certain subpopulations of the group’s patients are not getting mammography or colon cancer screening according to standards of care and figure out why, inclusive of sociocultural factors, and address it head on.

I hope this does not come off too snarky because I have great respect for you, but your apparent inability to step back and consider the forest, your perception that talking about the forest is somehow a threat to your relationship with the tree, is an illustration of why physicians need these subjects as part of their education from the get go, more than being able to recognize which is an intermediate in the reaction of benzene with Br2 and AlBr3.

*In the room some. I deal with identifying and referring mothers who have postpartum psychiatric illness, kids who are transgender, and a host of other issues, cultural, mental health, and otherwise. Undergrad level classes in psychology did not teach me about all of these but they did give me a basis that made it easier to learn.

**The MBAs appropriately care about the bottom line and let’s face it, we all want good compensation too. We however are in it for a longer haul so take a longer term perspective and we also have our egos in the mix. Our egos demand that we also do good while doing well. If want real quality of care to not be sacrificed we need to part of leadership and preferably owners of that which owns us. IMHO.