Interoffice Memo: Medical Edjumacation

The Volgi sends this interoffice memo:

To: Dr. J.

From: Confucius, The Oecumenical Volgi, (The Notorious OEV).

RE: MCAT Changes

Dear Dr. J.:

MCAT changes: More NAMS or fewer Tiger Cubs? Link

What do you think is going on here? 



Dear Volgi,

Terrific question, and one that must be answered for all of our minions.

You may recall the parable of Dr. Rarity, Dr. Rainbow Dash and Dr. Darth Ponicus.

In that essay Dr. J. posited that there are right brained, left brained and whole brained doctors. Dr. Rarity is smart but wants to be popular and lets her clinical judgement be clouded by that desire. Dr. Rainbow Dash is smart and competent and wants to do the right thing, but has trouble when a patient wants the wrong thing rather than the right thing. Lastly, there’s Dr. Darth Ponicus. He is both savvy and silver-tongued. Not only is he a skilled physician, but can also communicate why his treatment strategy is the course of action the patient really wants.

Now, on to your question:

iSteve’s blog post takes umbrage with the notion that the MCAT, the SAT’s for medical school will be ‘squishier’ because in addition to testing aptitude and knowledge in the physical sciences, biological sciences and verbal reasoning, new sections on social/behavioral sciences and critical thinking that covers ethics and cross-cultural sciences will be added.

He links to a New York Times article not written by our favorite buffoons Paul Krugman or Maureen Dowd, but someone named Elizabeth Rosenthal, who I am sure is a lovely human being.

iSteve is iCritical of this notion because he fears that this is typical Obamainan Social Engineering of the worst order. He fears the new MCAT will result in admitting ‘dumber kids’ or at least kids who don’t have the scientific savvy to be clinically competent physicians. Dr. J. does not like that he injected an element of race into his polemic (NAMS = either Non-Asian Minority Students or Non-Asian Medical Students depending on who you ask).

His concerns are completely understandable in that he was misdiagnosed by an not-so-competent sounding nice guy and his malignancy was cured by a brilliant ass-hat.

Dr. J. finds it absolutely tragic that in the 3 short years that the President Obama’s been president that his pronouncements against physicians, jamming through of Obamacare and creating the #HHSmandate, that when the academic medical community attempts to do something good, it is seen with greater mistrust.

Insert Digression Here:

Recently there was a kerfuffle regarding the American Society for Clinical Oncology, American College of Cardiology and other medical societies calling into question their own excessive use of certain tests and treatment that include:

  • Repeat colonoscopies within 10 years of a first test
  • Early imaging for most back pain
  • Brain scans for patients who fainted but didn’t have seizures
  • Antibiotics for mild- to-moderate sinusitis unless symptoms last for seven or more days or worsen
  • Stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present
  • PAP smears on women younger than 21 or who have had a hysterectomy for a non-cancer disease
  • Advanced imaging or bone scans in patients with early-stage breast or low-grade prostate cancer
  • Bone scan screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors
  • Routine cancer screening on dialysis patients with limited life expectancies
  • Chemotherapy for sickest cancer patients 

  • End Digression.

    Dr. J. is only mentioning this to make the point that these recommendations were met with mistrust and people decrying ‘Death Panels’ and such. These guidelines were put forth by experts in the field in order to avoid big brother cracking medical skulls. They were met with a jaundiced eye, much as this MCAT change is being met due to assumptions that they are part of an Obamacare related conspiracy (which neither is).
    Similarly, iSteve, who Dr. J. likes a great deal, is just as skeptical regarding the MCAT change.
    Dr. J. however, is here to say that these changes are a very good idea.
    First, the NYT article mentions that there are 44,000 applicants for 19,000 medical school spots each year. We aren’t hurting for applicants, let alone qualified applicants. What the American Association of Medical Colleges (AAMC) has realized is something we have known at New Atlantis Ivory Tower Medical School for quite sometime, and that is that a doctor is more than someone that is an exceptionally skilled technician. A doctor must also be ethical, honest, a problem solver, an educator and communicator.
    Dr. Kirch the president of the AAMC is right when he says, “The Goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.”
    The AAMC put forth personal competencies that it is recommending that medical schools look for in applicants to medical school above and beyond being smart. Those are:
    • Integrity and Ethics
    • Reliablity and Dependability
    • Service Orientation
    • Desire to Learn
    • Resilience and Adaptability
    • Social and Interpersonal Skills
    • Written Communication
    The current MCAT does not test these skills. 
    An ability to understand behavorial/social science is important, for example in that it is important for a physician to understand how his patients think and react to what he is telling them. As much as sociology and anthropology bore Dr. J. to tears, he knows it is important to learn how an individual’s cultural background informs their interaction with their physician. It is necessary for him to deliver the best care to them that is possible. Trust Dr. J. when he says he has taken care of many very different patients from very different backgrounds. Being able to comprehend the information one needs to learn in order to do it is as critical component as being able to comprehend organic chemistry.
    What the changes to the MCAT bring will be an ability to evaluate additional dimensions of the applicant. 
    Right now, in order to decide if we like an applicant, we have the MCAT (2 science, 1 verbal and 1 essay sections) a transcript, a personal statement, a list of activities, and an interview or two.
    The kids are so coached nowadays that the MCAT scores are higher than they should be, grade inflation has made the GPAs higher than they should be. The personal statement now reads 90% of the time like a Mad Lib where they filled in blanks in a homogeneous template (as advised by their college pre-med advisor), and they all come to interviews looking the same and acting the same and answering the questions the same. 
    When Dr. J. asks them what kind of doctor they want to be when they grow up, even though their personal statement is all about their brother Kenny dying of cancer, they answer saying, “I have an open mind” rather than say, “My brother Kenny’s battle with cancer has inspired me to be an oncologist, I am just not sure if I want to do surgical oncology or radiation oncology as I shadowed a surgeon and did some research in the lab of a radiation oncology while in college.”
    When Dr. J. interviews a candidate, he spends all of his time trying to see past the pre-med advisor BS and see the real candidate. With one young lady, who was a drama minor in college, this was the ultimate verbal chess match. He did checkmate her in 29 moves, however.
    Dr. J. believes that the new MCAT will just give us additional information to work with, rather than create squishy medical students and future doctors. Medical Schools won’t say, “Gee, this guy got a B- in Organic Chemistry, but that’s ok because he had a 14 out of 15 in Social Science on the MCAT.” 
    As iSteve pointed out, there will be applicants that will rock all sections of the new MCAT. Those are the folk who every one will want. The test is not being re-designed such that you will do well in one section, or another. Similarly, a doctor must be clinically competent, first and foremost, but we will do a better job making sure that their ability to interact with you will be better as time goes on. Dr. J. strongly believes it is not a zero sum game. Thusly, he would go to Dr. Darth Ponicus first, Dr. Dash second and Dr. Rarity last. 
    Now if we could do something about those resident work hour restrictions rotting medical education from the inside out…

    About Dr. J.

    Dr. J. was born the son of a New Atlantean sharecropper who cornered the market on notoriously delicious seaweed Himanthalia elongata (popularly known as Thongweed). With his newly minted seaweed fortune, Mr. J. the Elder sent his son to attend the Academy of Sorcery, Alchemy and Surgery where the good doctor apprenticed with the finest sorcerer surgeons in New Atlantis. Dr. J.'s areas of expertise grew to include bleeding, cutting for stone, trephination, medical divination with outstanding spatial and temporal resolution, cybernetic sorcery and medicinal alchemy. When King Orin of Atlantis fell ill with the Ick, Dr. J. stepped in with an elixir he devised from a combination of minerals, herbs and saps. Curing the king, Dr. J. gained significant notoriety which afforded him the luxury of time to devote himself to his side hobbies which include porpoise racing, the study of supply-side economics, cooking and raising his lovely merchildren alongside his lovely bride the archconservative Mrs. Dr. J.