Peer Review

From the Editor

In this issue of Peer Review, produced with generous support from the Howard Hughes Medical Institute, we feature articles representing a range of experiences—medical educators, dental educators, health advisors, social scientists, and foundation professionals—and address the significance of the Medical College Admissions Test (MCAT) changes in the undergraduate curriculum for future physicians.

American Association of Medical Colleges (AAMC) president and CEO Darrell Kirch recently commented on the upcoming changes to the MCAT. He noted, “Being a good doctor is about more than scientific knowledge. It also requires an understanding of people. By balancing the MCAT exam’s focus on the natural sciences with a new section on the psychological, social, and biological foundations of behavior, the new exam will better prepare students to build strong knowledge of the socio-cultural and behavioral determinants of health.”

Everyone has his or her own idea of what the traits of a “good doctor” are, but to get a better sense of what research says on this topic, I consulted an article titled “What Patients Want: A Content Analysis of Key Qualities that Influence Patient Satisfaction,” published in the March/April 2007 issue of Medical Practice Management. The authors write about an online survey in which patients reflected on experiences with their personal physicians. These survey results revealed that, “Patients value factors such as access, engagement, and personal attention,” in addition to technical expertise. The article summarized the results by noting that “a practical use of these findings would be more emphasis in physician training…in developing skills that can result in clearly communicating, expressing empathy, and supporting patient information needs.”

The Journal of the American Medical Association (JAMA) also champions development of these broader skills sets by including two distinctive features. First, in addition to the inclusion of many cutting-edge, research-based articles that the journal is known for, in every issue they also publish first-person essays in a department called “A Piece of My Mind.” These essays—written mostly by physicians, but also by other health care professionals and patients—offer insight into the daily experiences and relationships of those in the medical world. JAMA also includes a reproduction of a piece of fine art on every cover and an essay that reflects on that artwork inside the journal. In expressing why fine art is appropriate for the cover of a medical journal, M. Therese Southgate, a physician and editor who for more than two decades chose the artwork and crafted the accompanying essays, wrote, “Both medicine and art are about seeing, first with the eyes of the body, but if one is attentive enough, then with the eyes of the mind and of the heart.”

Former JAMA editor George Lundberg wrote that one of his journal’s objectives is to “inform readers about nonclinical aspects of medicine and public health. . . . Our JAMA art covers and cover stories help us meet that objective every week. In fact, they formed the beginning of our whole JAMA initiative to emphasize the humanities in medicine.” JAMA clearly values the humanistic aspects of medicine. Ideally, the new MCAT changes will assist in admitting medical students who not only have strong scientific knowledge, but who also appreciate the rich physician–patient engagement celebrated by the journal.

In addition to bringing more balanced candidates to medical training, the undergraduate curriculum changes suggested by the new MCAT reflect the type of integrative thinking that AAC&U recommends for all undergraduate students. In this issue, AAC&U announces the new Scientific Thinking and Integrative Reasoning Skills (STIRS) project, which builds on AAMC’s new Science and Reasoning Skills (SIRS) framework. The AAC&U STIRS project aims to ensure that college graduates can use scientific reasoning to gather and evaluate evidence, understand how scientific and social scientific studies are designed and executed, use statistical reasoning to evaluate data, use data to communicate effectively, and base decisions on analysis of evidence, logic, and ethics. Through this project, AAC&U seeks to prioritize attention to scientific thinking and integrative reasoning in the national conversation about general education and liberal learning.

Developing the STIRS capacities is certainly mandatory for our future physicians, but achievement of them is also desirable for students of all majors. As AAC&U leaders have argued since the launch of the LEAP initiative, integrative reasoning is the twenty-first-century liberal art.

We gratefully acknowledge this issue’s editorial planning committee members—Kenneth C. Burtis, Susan Elrod, Robert C. Hilborn, Kevin Hovland, and Richard K. Riegelman—for their work in developing the following content on implications for the upcoming MCAT changes.

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