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The New Social and Behavioral MCAT Requirements: Inspired Innovation, Missed Opportunity, or Both?
The influence of the modern medical school on the liberal arts education in this country over the last decade has been baleful and malign, nothing less.
—Lewis Thomas (1978)
The implementation of the new Medical College Admissions Test (MCAT) in 2015 will cap off over a century of discussion on the efficacy of various premedical curricula (Chambers et al. 2011) and provides an opportunity for the influence of premedical programs on liberal education to become not merely benign but highly positive. The Final Recommendations of the Association of American Medical College’s MR5 Committee (AAMC 2011a) call for the new MCAT to include a social and behavioral science component equal in scope to the biological and physical sciences portions of the exam. The test developers indicate that there will be approximately sixty-five questions in this section, taking approximately ninety-five minutes to complete. The committee proposes that 60 percent of this section be based on psychology, 30 percent on sociology, and 10 percent on biology, although they note that these percentages might change. There are twelve proposed foundational areas in the test that address the major psychosocial themes (see fig. 1). The proposed undergraduate coursework for these sections includes one course each in psychology and sociology, and two biology courses. These will be introductory courses, as more advanced courses in these fields usually require completion of the introductory courses as prerequisites.
We think the greater emphasis on psychosocial issues is very important because medically or biologically based disorders do not occur in isolation, and their prevention and treatment involve human activities, both on the part of the patient and the health professional. This concept is often referred to as the “biopsychosocial model” (Taylor 2012). It is imperative to emphasize an understanding and appreciation of the reciprocal relationship between environmental/psychological variables and issues related to health on the MCAT. Overall, a greater understanding of these variables will result in greater advances in medical science and greater proficiency in medical practice, including improved success in preventing, diagnosing, and treating disease and injury. Such understanding also is necessary to enable patients to comply with health maintenance and treatment plans. The dramatic demographic changes occurring across America also provide ample impetus for future physicians to increase their understanding of “the ways that individuals perceive, think about, and react to the world” (AAMC 2011b) in order to practice their craft successfully.
Still some issues remain unresolved. The most pertinent is whether the coursework that is suggested to prepare the test takers for this section of the MCAT is really designed and taught in a way that will accomplish proficiency. One concern is whether current course curricula and materials will prepare students to answer these types of questions; a second is whether the material in such courses is presented in a way that facilitates the type of understanding that is required of examinees taking the MCAT. To understand this fully, one first needs to look at the type of knowledge that will be tested.
Sample questions provided by AAMC (2011b) to represent the types of questions that would occur in the psychological, social, and biological foundations of behavior science section of the test have a uniform style. First, they provide a brief synopsis of a research study along with a figure depicting the results. Subsequently, the test asks five questions pertaining to the study. A portion of the questions have to do with the application of existing knowledge to the questions asked. For example, a student might be asked which brain region is associated with the issue described in the study. In this case, the answer may have been taught in the neurology section of an introductory psychology course, and hopefully will be recalled during the test. The remainder of the questions— and it appears to be greater than 50 percent of them—involve the application of the scientific method to the interpretation of findings from the study. Content and definitional knowledge appear to be relevant to answer these questions too, but it seems that the core concepts focus on evaluating the study’s design and making sense of the findings.
A review of undergraduate syllabi in introductory psychology courses revealed that much of the proposed MCAT content may be covered when professors closely follow a textbook (Bates 2004). Just about every content area listed in figure 1, is included in introductory texts but the coverage typically is cursory at best. For example, conceptualization and diagnosis of psychological disorders is covered in a few pages at the beginning of one chapter, with disorder specific information limited to perhaps one paragraph each. The coverage of disorders typically provides only a definition of each disorder. There is insufficient space allocated to address issues related to etiology, maintenance, or treatment.
The function of an introductory course is to provide an overview of the major areas in a field. There simply is not time to provide deeper coverage of many areas. Strong instructors and increased study by the student can certainly increase the functional knowledge gained in introductory courses, but that may or may not achieve the desired end. A study of undergraduate psychology curricula by the American Psychological Association (Halpern 2010) concluded that: “Although many institutions already standardize the textbooks adopted for the introductory course, few standardize the content of what is taught. … Given that the introductory course serves as a foundation for the major and is sometimes the only exposure to the field for nonmajors, widely variable content and delivery do the field and the student a disservice.” Thus, it seems unwise to assume that students who take only an introductory psychology course will be well prepared for the new social and behavioral section of the MCAT. We suspect that the same variability exists among introductory sociology courses.
Another option is to increase the number of courses suggested in these areas. This is a distinct possibility because there are higher level courses in each of the areas to be tested in the new MCAT. For example, there are courses on abnormal psychology that cover etiology, diagnosis, assessment, and treatment of psychological disorders. Such a course is likely taught at all undergraduate institutions that offer psychology as a major. Realistically, however, requiring additional courses is not feasible for a variety of reasons, and the MR5 Committee wisely advised against increasing the number of courses required for premedical students. Other ways to make the material covered in these courses more applicable for careers in medicine need to be considered. Perhaps one approach would be to reconstitute the manner in which these topics are covered in introductory psychology and sociology courses. This particular approach, which is also the one recommended by Halpern (2010), might result in an overall improvement in undergraduate general education.
Understanding the Philosophy of Science and the Scientific Method
As mentioned previously, it appears that approximately 50 percent of the content of the test questions on the new section of the MCAT have more to do with an understanding of what valid implications might be made from the study presented, rather than simply recalling previously learned material. Thus, the central issue appears to be one of understanding the philosophy of science and the scientific method. While philosophy of science and research methods may be covered in other undergraduate coursework, their application to these finer areas of psychology receive only cursory coverage in many introductory psychology courses (Bates 2004). Again, a quick review of introductory texts in these areas shows that about half of one chapter is devoted to research methods, experimenter biases, and heuristic errors. Unfortunately, either because they are so elementary, or this is not seen as a main focus for such courses, there is very little integration of teaching the application of the scientific method or the philosophy of science in many introductory courses. Specific instructors can choose to include these topics or not. Therefore, we suggest that either social psychology research methods courses are also taken as part of the premedical curriculum, or greater emphasis be given to philosophy of science and research methods throughout introductory courses. This would include teaching and discussions related to types of epistemology and other issues of knowledge and understanding. The scientific method holds special value as a form of epistemology, and its applications and ramifications should be understood. One option is to increase time spent on philosophy of science and the scientific method earlier in introductory courses, and then present all following material in this context.
Figure 1. Psychological, Social, and Biological Foundations of Behavior Concepts to be Tested on the New MCAT
Biological, psychological, and socio-cultural factors influence the ways that individuals perceive, think about, and react to the world, including
Biological, psychological, and socio-cultural factors influence behavior and behavior change, including
Biological, psychological, and socio-cultural factors influence how we think about ourselves and others, including
Social and cultural differences influence well-being, including
Social stratification affects access to resources and well-being, including
Source: Association of American Medical Colleges. 2011. MR5: 5th Comprehensive Review of the Medical College Admission Test (MCAT®): Final MCAT® Recommendations
For example, a typical introductory psychology course would provide information on the history and background of the field of psychology, including the varying views of where knowledge comes from. Consequential sections would focus on research methods, personal biases, and heuristic errors. All following chapters—including ones on neurosciences, sensation and perception, learning, motivation, human development, and so on—would occur with an underlying discussion of why professionals view these things in such a particular way. The course may cover less factual content but more process, as well as the reasoning and evidence upon which scientists believe something to be so.
The New MCAT Requirements and Liberal Education
While the MR5 is going in the right direction with regard to the content areas they suggest be learned by students taking the MCAT, their recommendation (AAMC 2011b) that the proposed exam for the social and behavioral sciences will “target concepts taught at most colleges and universities in one-semester introductory psychology and one-semester introductory sociology courses” is not the optimal strategy. Introductory courses in psychology and sociology provide only an overview of these topics rather than their actual application as they will be covered in the new MCAT. It is unlikely that existing introductory psychology and sociology courses at most universities include the important information that AAMC suggests premed students study prior to taking the social and behavioral section of the new MCAT (table 1). Thus, some universities might respond by developing new introductory sociology and psychology courses specifically designed for premed students. This would result in a missed opportunity, not only for premed students but also for other students across the university and for faculty as well.
Thomas (1978) and others (e.g., Gunderman and Kanter 2008) have made it clear that (1) the premedical curriculum exerts enormous influence on general education requirements at many universities and (2) there is much to be said for not sequestering premedical students from their peers in other disciplines during the undergraduate years. Instead of bemoaning or resenting the effects that premedical programs have on general and liberal education, they should be used to the advantage of all. Indeed, many, if not most, of the recommended topics for the social and behavioral section of the new MCAT are equally valuable to any undergraduate student and are suggested by the American Psychological Association for undergraduate education in psychology (American Psychological Association 2007). Specifically, in an age where patients are “consumers of health care,” knowing ways in which to judge treatment options or interpret advertising for health care options would help individuals seek out medical choices that are more likely to be helpful. Similarly, there is utility in having wise consumers who have methods to judge when treatment is not working, and the competence to look for alternative options and evaluate their utility.
This might also aid in the prevention and implementation of medical treatment. If patients understand their own motivations to follow or not follow treatment plans and health maintenance regimes, it is likely that their compliance will improve. It can be argued that bankers, real estate agents, theater professionals, artists, English teachers, political scientists, and historians will be more successful if they, too, understand the biological, psychological, and social basis of human behavior.
Furthermore, all of our undergraduates will be exposed to the same changing demographics and cultural shifts in their professional lives that future physicians will encounter in theirs. All of our students will be faced with an increased diversity of beliefs, communities of mixed ethnicity, cultural complexity, and economically disparate populace. Similarly, to be culturally competent within a community, one needs to be able to see others’ points of view, have empathy for the choices they make, and have the character to treat others with civility (Fluker 2011). This involves understanding why individuals of different backgrounds make the choices they do, and then adjusting the context and our actions to incorporate their worldviews.
Rather than relying on individual colleges and universities to come up with their own tailor-made programs for premed students (Chambers et al. 2011), or assuming that existing introductory coursework in sociology and psychology will somehow prepare students for the new MCATs, the AAMC could use its enormous influence to help us change the very nature of general education. By joining with organizations such as AAC&U, AAMC could help bring about a fundamental change in liberal arts education in the social and psychological sciences—to the benefit of all undergraduates. The MR5 recommendations “require examinees to use knowledge of social and behavioral sciences concepts to demonstrate skill in scientific inquiry and reasoning, research methods, and statistics.” What student in any discipline could fail to benefit from such a requirement?
We also believe that most students across the university campus could benefit from exposure to much of the other content necessary to prepare premedical students for taking the new MCAT. As pointed out by the authors of Rising Above the Gathering Storm Revisited (National Academy of Sciences 2010), “[T]he need to strengthen science and math education in the nation’s public schools is not simply to produce more graduates possessing the qualifications needed to pursue careers in science and engineering. The spectrum of jobs that is available to high school as well as college graduates is increasingly demanding at least rudimentary skills in these fields.” Much of the content in the natural sciences sections of the proposed new MCAT also would benefit any denizen of an advanced technological society. The Critical Analysis and Reasoning Skills (CARS) section, in particular, tests skills that are necessary for anyone who seeks to be an informed maker of choices in a democratic society. Again, what individual would not benefit from the CARS skills specified by the AAMC (2011b, 133):
- Foundations of comprehension
- Understanding the basic components of the text
- Inferring meaning from rhetorical devices, word choice, and text structure
- Reasoning within the text
- Integrating different components of the text to increase comprehension
- Reasoning beyond the text
- Applying or extrapolating ideas from the passage to new contexts
- Assessing the impact of introducing new factors, information, or conditions to ideas from the passage
Indeed, in these times of ideological predominance, the ability to become adept at “evidence-based problem solving” (Riegelman 2012) seems essential not just for health care professionals but for all citizens. As universities prepare premedical students and their fellow students throughout the campus for their future roles as professionals and workers, we would do well to remember the following warning recently provided by the National Task Force on Civic Learning and Democratic Engagement in A Crucible Moment (2012):
Higher education in a robust, diverse, and democratic country needs to cultivate in each of its graduates an open and curious mind, critical acumen, public voice, ethical and moral judgment, and the commitment to act collectively in public to achieve shared purposes. In stark contrast, higher education in a restrictive, undemocratic country needs only to cultivate obedient and productive workers.
We agree that it is absolutely imperative for premed students to understand “the ways in which psychological, social, and biological factors influence our perceptions and reactions to the world, behavior and behavior change, what we think about ourselves and others, cultural and social differences that influence well-being, and the relationships between social stratification, access to resources, and well-being” (AAMC 2011b, 91). But it is equally imperative for all students to share in that same level of understanding if we are to continue as a strong democratic republic (Haring-Smith 2012).
American Psychological Association. 2007. APA Guidelines for the Undergraduate Psychology Major. Washington, DC: American Psychological Association. Available at: https://www.apa.org/ed/resources.html.
Association of American Colleges and Universities. 2007. College Learning for the New Global Century. Washington, DC: Association of American Colleges and Universities.
Association of American Medical Colleges. 2011a. MR5: 5th Comprehensive Review of the Medical College Admission Test (MCAT®): Final MCAT® Recommendations. Available at: https://www.aamc.org/download/273766/data/finalmr5recommendations.pdf.
———. 2011b. Preview Guide for MCAT 2015. Available at: https://www.aamc.org/students/download/266006/data/2015previewguide.pdf.
Bates, S. 2004. Coverage: Findings from a National Sample of Introductory Psychology Syllabi. Presented at the annual convention of the American Psychological Association, Honolulu, HI, July 2004. Available at: http://works.bepress.com/scott_bates/43/.
Chambers, D. A., R. Cohen, and J. Girotti. 2011. “A Century of Premedical Education.” Perspectives in Biology and Medicine 54 (1): 17–23.
Fluker, W. 2011. “Preparing Students for Ethical Complexity: The Quest for Character, Civility, and Community.” Liberal Education 97 (3/4): 14–21.
Gunderman, R. B., and Kanter, S. L. 2008. “Perspective: ‘How to Fix the Premedical Curriculum’ Revisited.” Academic Medicine 83 (12): 1158–1161.
Halpern, D. F. (Ed.). 2010. Undergraduate Education in Psychology: A Blueprint for the Future of the Discipline. Washington, DC: American Psychological Association.
Haring-Smith, T. 2012. “Broadening Our Definition of Diversity.” Liberal Education 98 (2): 6–13.
National Academy of Sciences. 2010. Rising Above the Gathering Storm, Revisited: Rapidly Approaching Category 5. Washington, DC: National Academies Press.
National Task Force on Civic Learning and Democratic Engagement. 2012. A Crucible Moment: College Learning and Democracy’s Future. Washington, DC: Association of American Colleges and Universities.
Riegelman, R. 2012. “Evidence-Based Problem Solving: Liberal Education and Preparation for the Health Professions.” Liberal Education 98 (2): 54–59.
Taylor, S. E. 2012. Health Psychology. 8th ed. New York, NY: McGraw Hill.
Thomas, L. 1978. “Notes of a Biology-Watcher. How to Fix the Premedical Curriculum.” New England Journal of Medicine 298 (21): 1180–81.
Nat B. Frazer is a professor in the Department of Environment and Society at Utah State University; Michael P. Twohig is an associate professor in the Department of Psychology at Utah State University.