Robert C. Bowman, M.D.
Numerous prospective medical students and their advisors are frustrated with
the current change to computerized testing. More than just MCAT Registration
concerns fuel the debates. The growing frustrations of those most aware of the
pipeline to medical school and the changes that are occurring will continue.
How will students deal with the current computerized problems when they
don't have top colleges or top advisors
have an advisor not on this list serve and far less experienced in finding the
answers
don't have professional or privileged parents who know how to handle such
situations, and not always in agreeable ways
don't have any advisor
don't have the money for a "Kaplan" professor or an advisor at all?
How many going through these complications and how many hearing about the
complications will think about trying again next year after a rejection?
What about top students by any measure who could choose any profession? Would
they maintain interest in medicine over business or engineering or other careers
when the very beginning appears poorly organized, unfair, or biased? Would we
actually drive off those with the social conscience that we need so much of in a
medical career?
Will those relatively new to the electronic age have even less confidence in
computers and computerized testing and have even more anxiety that will impact
computerized test performance?
Who will trace those who attempted to apply, and never overcame the new
obstacles? Who will track the contacts of these students (fellow students,
earlier class years, family, friends) who will get the impression that it is
even more difficult to gain entry to medical school?
How many will be frustrated with dealing with the process of trying to become
physicians that they will be even more likely to resent physicians in the future
in their other health careers, as leaders in other professions, etc.? In web
sites and in conversations with faculty I hear of potential California medical
students that are quick to claim discrimination. Some are Asian students from
just 4% of the population that already claim 23% of medical school admissions.
What about Asians or whites with only tenths of MCAT points difference who did
not get admitted, mainly because their parents were different than those who
were admitted?
How valuable is a few hours performance in a lifetime that includes infinitely
more numerous, longer duration, and more important areas relevant to physician
performance? One that is currently abused by organized campaigns with a narrow
agenda? One that limits medical school curricular improvement and development?
One that limits admissions of those most different who have different career,
location, and patient population preferences? One that limits the perspectives
of the admitted medical students who become the leaders of the nation?
Why don't we change admissions numbers and focus and costs to admit far more and
a much broader range of applicants with a plan to narrow this group down over
time? Why not turn evaluation over to a medical school experience that is 4
years long instead of 4 hours long? One with far more contact time with
evaluators, one that can measure performance over time, one that can evaluate
interactions with patients, staff, supervisors, and others? Why not have more
with medical training but not necessarily medical degrees, often by their own
choice as much as by the school?
Why do we expend all of our evaluation resources on a standardized test rather
than exploring factors likely to be more related to long term physician
performance? Why does our nation fail to explore these areas most related to
future performance as a nation as related to the qualities and quality of
professionals? What does our nation say about these areas?
Of
those who stood with President Bush last night to be recognized for their
outstanding contributions to the nation in a wide range of activities, only
one might pass the MCAT given background. She has made far more money by working
the standardized test performance improvement angle. She will continue to do
well because she has the first shot a children before age 2, before new parents
realize that their children are as limited by their environments as they are by
access to Baby Einstein materials.
We are 80 years beyond the developers of standardized testing that noted that
physician performance would not be linked to such testing. see Thorndike below
or references at History of the MCAT from
the McGaghie JAMA article
Again more than just standardized testing is involved. What happened to the
wisdom of the ages and the critical and ongoing debates that helped shape top
notch American medicine, health care, and education? Where are the constant
debates that used to dominate any thought of changes in admissions or testing
that might shift the balance toward narrow science focus and away from a focus
on people orientation? The debate about the art and science aspects of medicine
have ended and medical education reforms helped put them to rest 100 years ago.
The science of the art of medicine is now real science involving quality, costs,
access, and relationships involving people. The basic science, academic rigor,
and intellectual focus of what used to be the sole "science of medicine"
remains, but how valuable is this in isolation. How important is this without
the direction and guidance from leadership that is aware and understanding of a
wide range of perspectives. How critical is this when medical leaders can
facilitate or retard the future development of the entire nation in their
recommendations that impact health care costs and all other businesses,
education, and activities in the nation?
From the Indiana University site: "Thorndike and his students used objective
measurements of intelligence on human subjects as early as 1903. By the time the
United States entered WWI, Thorndike had developed methods for measuring a wide
variety of abilities and achievements. During the 1920's he developed a test of
intelligence that consisted of completion, arithmetic, vocabulary, and
directions test, known as the CAVD. This instrument was intended to measure
intellectual level on an absolute scale. The logic underlying the test predicted
elements of test design that eventually became the foundation of modern
intelligence tests."
"Thorndike drew an important distinction among three broad classes of
intellectual functioning. Standard intelligence tests measured only "abstract
intelligence". Also important were "mechanical intelligence - the ability to
visualize relationships among objects and understand how the physical world
worked", and social intelligence - the ability to function successfully in
interpersonal situations". Thorndike called for instruments to develop measures
for these other types of intellect. "
"Thorndike developed psychological connectionism. He believed that through
experience neural bonds or connections were formed between perceived stimuli and
emitted responses; therefore, intellect facilitated the formation of the neural
bonds. People of higher intellect could form more bonds and form them more
easily than people of lower ability. The ability to form bonds was rooted in
genetic potential through the genes' influence on the structure of the brain,
but the content of intellect was a function of experience. Thorndike rejected
the idea that a measure of intelligence independent of cultural background was
possible."
Publications
Educational Psychology (1903) , Introduction to the Theory of Mental and Social
Measurements (1904) , The Elements of Psychology (1905) , Animal Intelligence
(1911) , The Measurement of Intelligence (1927) , The Fundamentals of Learning
(1932) , The Psychology of Wants, Interests, and Attitudes (1935)
"Thorndike proposed that there were four general dimensions of abstract
intelligence:
Altitude: the complexity or difficulty of tasks one can perform (most important)
Width: the variety of tasks of a give difficulty
Area: a function of width and altitude
Speed: the number of tasks one can complete in a given time .
His intellectual development of this multi-factored approach to intelligence
contributed to a great debate with Charles Spearman (Spearman proposed a single,
general intelligence factor 'g') that encompassed twenty five years."
The above from
http://www.indiana.edu/~intell/ethorndike.shtml
For decades we have known at least enough to figure out that wide latitude was
needed regarding testing and that interpretations of such testing should also be
broad. More than a few areas of exploration have been noted. Those intimately
involved in standardized testing have also revealed that some of these promising
lines of investigation have been squelched (Anthony Carnevale, former ETS VP)
There is now no doubt that those
who are different in age, parent income, parent occupation, socioeconomics,
culture, language, or proximity to medical school face greater barriers to
admission and are
more likely to serve patients in need of care. There is even some reason to
support that these physicians will deliver better quality of care at least for
populations most like them and perhaps others. There is clearly evidence that
higher income Americans are separating from lower and middle income Americans
and this is also true in those admitted to medical school, a reliable pathway to
higher income levels. Although few can or should doubt the validity of the MCAT
or other standardized testing, it is the use and interpretation of such testing
that is a concern.
It is not the fault of AAMC or any association that Americans have developed a
distorted view of the validity of such testing, but it is the responsibility of
AAMC and any others developing such testing to constantly inform the public of
limitations in testing. They must also remove obstacles not related to future
performance as physicians or as leaders of a nation. Declines of 30,000 taking
the SAT test should be the subject of national investigations and efforts to
restore access. Any declines in the numbers or types of students taking the MCAT
should also be explored thoroughly. Medical education leaders seem to be aware
of some of these problems, but it seems that more than a few
Jordan Cohen
addresses are required. More accountability is needed such that deans
and other leaders promote these values, explore new approaches, and strive for
consistent progress in evaluation and assessment. They may even have to
specifically fund individuals to do this work even when grants do not exist.
It is also our duty as Americans to inform AAMC and any others that fail to
address areas that threaten our health care, education, security, medical
education, or any other systems in the United States. At a time when editors of
Academic Medicine are asking for new perspectives to guide the next 100 years,
AAMC should be asking as well. We are registering our concerns and asking for
improvements.
We are not blaming those who are attempting to implement the policies involved
who are caught in the middle of the process and the debates. We are asking for
an examination of the process and how important this process is to becoming a
top quality physician. We are holding the process of premedical preparation and
admission accountable to the same standards as the standards for physicians. We
gather information, we learn, we make the best predictions as to who will make
the best physicians, and we make the changes to accomplish this. Hippocrates
noted the same concepts in
Epidemics, Bk. I, Sect.
XI. One translation reads: "Declare the past, diagnose the present, foretell the
future; practice these acts. As to diseases, make a habit of two things — to
help, or at least to do no harm."
Robert C. Bowman, M.D.
[email protected]
Admissions Ratios, Changing Admissions, and Physician Distribution
Ethnicity, Gender, Admissions, and Distribution of Physicians
Facilitating Physician Distribution
Admissions Package
www.ruralmedicaleducation.org