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Fall 2013

The Price of Admission

Date: October 1, 2013

The Price of Admission

I didn’t grow up playing with a stethoscope, or dreaming of being a medical student. I headed to college to pursue my interest in language and travel. The intrigue of authoritarian dictatorships and economic development in Latin America captured my interest first in college and eventually as a doctoral student.

Sometimes life has twists in store for us, however. Somewhere between Juan Peron’s Argentina and the Mexican Debt Crisis, I realized I wanted to incorporate a more tangible human component into my everyday life. The idea of entering medicine came to me piecemeal through shadowing and speaking to those in the medical field. But when it came to committing to the medical path and completing premed requirements, I had to strike a careful balance between my work as a PhD student and the basic science courses necessary to prepare for medical school.

It’s a story familiar to many non-traditional students in medicine. When inspiration from a previous career leads us to medicine, how can we navigate the road that more traditional premed students have doggedly been following since their first year in college?

The cornerstone of preparation for medical school in recent years has been completion of an undergraduate program and specific courses from the basic sciences. Students must then complete the Medical College Admissions Test, or MCAT—a test that helps differentiate between applicants with near-perfect grades, college leadership positions, and shadowing experience.

In 2015, the Association of American Medical Colleges (AAMC) will be introducing a substantially different MCAT.  In addition to the chemistry, biology, and physics questions on the current exam, the new MCAT will test material taught in introductory psychology, sociology, and biochemistry. The purpose of the new emphasis on social and behavioral sciences, according to AAMC President and CEO Darell G. Kirch, is the recognition that “being a good doctor is not just about understanding science … it is also about understanding people.”

At its core, the initiative to recruit broadly trained students shows insight into the more humanistic and less tangible aspects of medicine, offering opportunities for students trained across the liberal arts to showcase strengths that lie outside premedical science courses.

Nonetheless, adding introductory psychology is only one very specific method of assessment.

When I decided to pursue medicine in my mid-20s, I had never taken a single psychology, sociology, or biochemistry course. I started the long medical career trajectory later than most students knowing that I could finish the premedical course work in two years. Had I been required to take courses or pass an assessment in the additional subjects of psychology and sociology, it would have added another year and thousands more dollars to my career path—and I might have given up before I started. 

In this way, the new MCAT puts a particularly difficult burden on exactly the students the AAMC hopes to attract—those who have a broad range of interests and who spent their college careers, and perhaps a few years after college, pursuing important passions. Students who worked in the Peace Corps or Teach for America and majored in music or language or even political science will be a few critical steps further away from careers in medicine.

My own experience is not unique. Indeed, more than half of my classmates in the Class of 2016 here at Hopkins took at least one year off between college and medical school, and  many transitioned from different careers entirely. Often their career paths allowed little room for additional courses either as a college student or while in the workforce.

The new MCAT represents an important shift, and the AAMC should be credited for its insight. But introductory sociology isn’t the only place that students get perspective on the world; it’s simply one of the easiest skills to measure. The medical school interview has long served as a useful way to gauge the personal characteristics and values of applicants. What will be demonstrated on the new MCAT that would not have been demonstrated in an interview?

While the value of psychology and sociology training for future medical students is indisputable, so too is the reality that additional training could deter talented applicants.