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MCAT Up for First Revision in a Generation

The Medical College Admission Test is up for its first reorganization in a generation.

The MCAT under review by a committee of the Association of American Medical Colleges, which released preliminary recommendations for change in April. The recommendations will be considered in February 2012 and, if implemented, would apply to the MCAT starting in 2015.

While so-called "prelaw" students tend to major in broad fields such as economics, history and political science, in premed -- also not an actual major -- students overwhelmingly major in a narrow cluster of natural-science fields such as biology or chemistry.

Cathryn Coleman, 20, a junior at Rhodes College in Memphis, Tennessee, is majoring in biology and chemistry and planning on taking the MCAT in June. She said she welcomes the ideas of the proposed revision, the first since 1990.

"I had that scientific tunnel vision earlier on," she said, "but then I did my internship with the chaplain at Methodist North Hospital. We listen to patients. I've seen patients try to talk to doctors like people, and the doctors nearly run from them."

The new proposed exam would include four sections: one on biology, one on chemistry, one on "behavioral and social sciences principles," and a fourth on "critical analysis and reasoning skills" -- especially on the topics of "ethics and philosophy" and "cross-cultural studies."

In recent decades, medical doctors and other scientists have developed an increasing awareness of the role nontraditional fields play in the world of medicine. Psychologists, economists, sociologists, even urban planners have published studies linking, say, childhood trauma with adult-onset illness, or poverty and disease.

"Rapid changes in all scientific fields, the impact of behavior on health, and a more diverse population require tomorrow's doctors to be more broadly prepared," said Ronald Franks, the vice chairman of the association's review committee who is also vice president of health sciences at the University of South Alabama.

Shelley White-Means, an economist at the University of Tennessee Health Science Center, also welcomes the changes. She isolated a turning point in the 2004 publication of an Institute of Medicine book called "Unequal Treatment," which focused on health disparities.

"Physicians are starting to think of patients as more than just biological objects," she said. "These are people who live in a community, live in all kinds of balance that affect them."

Of the MCAT proposals, she added, "It's due. If it becomes part of your exam, you respond to it," noting that passing the MCAT is just about the best incentive to drive medical student behavior. "Incentives work," she said. "People do things in order to get what they want. And they want to pass this test."

In addition to changes in the test's structure, the committee recommended that the test "provide low-cost preparation materials" and "discounts or waivers on testing fees" for needy students (Coleman spent at least $200 on preparatory material, plus a $235 testing fee and another $60 fee to move her exam date from May to June). The test, which is already 51/2 hours long, will also be 90 minutes longer and nix the writing sample.

Those pushes are part of a plan to expand the population of doctors beyond its overwhelming demographic of affluent white and Asian-American candidates. In 2006, only 2.2 percent of medical students and doctors were African-American.

Coleman, who is white and also serves as president of Rhodes' Catholic Student Association, said that she has worked with fellow students and witnessed doctors during her summer emergency-room stints who "are just, like, I want to get in, fix this, move on and not really care about this beyond the short term, which is a problem because those patients might return and just repeat the whole thing."

They frustrate her, she said: "I just want to ask: why do you want to be a doctor? If you don't care about the patient as a whole, then what is your interest in medicine?"


The Commercial Appeal

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