A few days ago, Eduardo called to tell me that his father had died of COVID-19. I had met the first-generation college student in the emergency room a few months back while taking care of his father and had kept in touch to answer any questions on the medical school admissions process. Eduardo works as a harm-reduction counselor at a needle-exchange program on Manhattans Lower East Side and aspires to be an addiction psychiatrist. He completed his premedical course requirements by attending a community college in the evenings and was scheduled to take the Medical College Admissions Test in March 2020.
Then COVID-19 struck -- leaving Eduardo and his family devastated on multiple fronts. His five-person family of service-industry workers -- deemed essential in this pandemic -- lives in a one-bedroom apartment, making it nearly impossible to isolate and minimize the risk of exposure to the virus. With the exam officially postponed by test administrators and the unimaginable burden of personal tragedy, Eduardo feels depressed and deeply anxious. Among other things, he is worried that his personal circumstances and emotional state will impact his MCAT performance and chances of getting into medical school, and he does not have the luxury of deferring applications for another year.
While many have deemed the pandemic the great equalizer, capable of sickening anyone, data show that it hasnt affected all communities equally. The latest statistics from the New York City Department of Health show that the risk of COVID-19 mortality for African Americans and Latinos is nearly double that of Asians and whites. From a socioeconomic perspective, Hispanic and African American communities are experiencing greater poverty and unemployment and bearing a disproportionate burden of disease due to the greater likelihood of having lower-paying jobs in essential sectors such as food service and delivery, transportation, and health care. Multifamily households are also common among these communities, making it difficult to self-isolate or quarantine. Aspiring medical students coming from these backgrounds might find it difficult, if not impossible, to separate the impact of these unfortunate circumstances from their day-to-day lives for months, if not years, to come.
Medical school applicants from underrepresented groups have long been challenged by the MCAT. Stratification of the latest scores by race/ethnicity reveals stark disparities: mean percentiles for Asians and whites were 74th and 71st respectively, yet 47th and 37th for Hispanics and African Americans. While this divide may lead one to assume that the MCATs design, use or predictive value are inherently biased against African Americans and Latinos, the research suggests otherwise. Rather, systemic factors such as generations of low parental income, unequal educational opportunities, food insecurity and racism are more likely contributors.
The COVID-19 pandemic has only exacerbated these inequities. It is possible that the psychosocial and economic challenges that minority communities are facing during this pandemic, compounded with already existing structural barriers, may inadvertently lower MCAT scores for many applicants like Eduardo. Lower scores may even discourage them from applying to medical school altogether. Consequently, it may dissolve years of effort to diversify the physician workforce, which is critical to serving vulnerable communities.
But unprecedented circumstances also provide opportunities for bold measures, and one such measure may be to reimagine short-term changes to the applied use of MCAT scores in medical school admissions. Some near-term changes are already underway. The Association of American Medical Colleges is shortening the MCAT to exclude experimental questions. Additionally, California medical schools will offer secondary decisions even if MCAT scores are unavailable, with hopefully more schools following suit.
I would argue that in order to make the admissions process fair and equitable to all applicants, the MCAT should be optional in the upcoming enrollment cycle.
Importantly, there is already precedence for optional test score reporting in graduate and medical school admissions. As of last year, more than 70 institutions of higher learning, including Harvard, Stanford, Cornell and Princeton Universities, made the Graduate Record Examination optional for several biomedical master's and Ph.D. programs. Princeton reported that doing so has entirely changed the demographic landscape of its graduate school, with nearly 43percent identifying as minorities and 28percent identifying as low-income and/or first-generation students. Additionally, there are existing Early Assurance medical school programs at institutions such as Icahn School of Medicine at Mount Sinai and Zucker School of Medicine at Hofstra/Northwell that dont require the MCAT at all, and others where it is optional.
Obviously, there are many factors to consider: schools often use the MCAT as a practical screening modality to select for applicants they believe can achieve academic success. Medical school is academically rigorous, and schools need to be assured that students can do the work. However, the exam does not assess other factors that are equally critical to the quality and caliber of physician one might become, including professionalism, integrity and interpersonal skills. Additionally, the weight attributed to the MCAT as a performance indicator of academic success will likely evolve once the United States Medical Licensing Examination Step 1 is offered pass/fail. Making the MCAT optional can encourage committees to weigh other attributes and metrics not only in final admissions decisions but also initial interview considerations. This can promote greater equity throughout the process, especially opportunity access for underrepresented minorities and those negatively impacted by COVID-19.
Some might argue that MCAT scores are critical to national rankings of medical schools -- which often impact student enrollment decisions. If medical schools are truly committed to equity in admissions, though, they should be able to deprioritize rankings-related concerns in the short term and instead emphasize the equitable measures they are implementing to attract the best and most deserving students. Additionally, medical scientist training programs often have MCAT reporting requirements to the National Institute of General Medical Sciences (NIGMS). Perhaps the NIGMS can waive the requirement to account for near-term equitable accommodations.
Implementing an MCAT-optional admissions cycle would undoubtedly require a very nuanced approach. Medical schools would need to make those decisions independently. But they would also need to be explicit in their messaging to applicants that there are no ulterior disadvantages to forgoing the test, as applicants often view such policies with suspicion and caution -- convincing themselves that the policy is in name only. What about applicants who have already taken and/or retaken the MCAT prior to COVID-19-related cancellations? AMCAS, the application service, could introduce a feature whereby applicants can decide if they want to send their scores to medical schools or not. If they choose not to, the feature should require them to explain why. Medical schools could also update their secondary application templates to allow applicants to explain if and how they were impacted by the pandemic.
Every day, we deem our own professionals heroes for fighting COVID-19. Now, we must also take similar heroic steps and make sure that every aspiring physician, including disadvantaged minority applicants like Eduardo, gets a fair chance in the admissions process. The time is here, and the time is now to reimagine the richness of a diverse physician workforce. And a critical first step is through reimagining the applied use of the MCAT and making it optional.
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