If you know an aspiring medical school hopeful, you have probably witnessed their frantic MCAT prep and watched them stay up late trying to stick to those medical school GPA requirements. And while strong academic acumen is important for a future physician, it has traditionally been prioritized over many other important professional competencies we desire to see in our physicians. Some medical schools, to this day, will weed out applicants at early stages of the admissions process using the GPA and MCAT criteria without even looking at the rest of their applications, including essays, extracurriculars, and reference letters. Mostly, this is done due to incredibly high competition. Weeding out applicants based on statistics helps institutions make the applicant pool manageable. However, this does raise the question of how holistic and fair the admissions process is when it comes to forming the future of medicine. This is not to say that academic history and tests are obsolete, but they cannot be the only measuring stick we use to select who will become good doctors.
And while medical schools claim to use a holistic approach to applications, what can admissions essays and interviews really tell them about the applicants? And if anything, should we be worried about the possibility of bias that may result from these admissions tools?
Why GPA and MCAT?
Simply put, medical schools claim that GPA and MCAT can demonstrate your academic proclivity. It’s a very traditional and perhaps a little outdated way of looking at learning prowess, but your grades and test scores can sometimes indicate whether you will have the ability to handle the academic workload expected of medical school students.
The problem with this view, however, is that considering GPA and MCAT the only measures of intelligence can lead to bias against those who simply could not afford to spend most of their time studying or preparing for a test. For example, if you are from a certain socio-economic background, you might have had to keep a part-time job throughout college. Which would, in turn, affect your schedule and ability to dedicate time to MCAT prep or extra credits for college courses. The lack of these opportunities hardly indicates your levels of intelligence or abilities – they are simply circumstances that you cannot always control.
And what’s more, latest SortSmart studies show that while using the GPA and MCAT for admissions seems to be favoring applicants from higher-income households, services like MCAT prep courses and MCAT tutors are equally used by applicants from lower-income and higher-income households! Seems like prep help may be one of the only ways to bridge that gap between students who have ample opportunities to get great GPA and test scores and those who may be at a disadvantage when the GPA and MCAT are considered the be-all and end-all of medical school admissions. In other words, it’s an opportunity for these students to show that with a little extra time and help they can achieve great heights in the academic realm.
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Why Medical School Admissions Essays?
The medical profession in the United States and Canada has dedicated decades to developing educational frameworks that would help medical schools and other educational institutions select only the best candidates for this important and demanding profession. In the United States, the core professional competencies outline the qualities and abilities each medical school student should possess, while in Canada, the CanMEDS framework demonstrates the roles a future physician is expected to fulfill. Based on these frameworks, it is easy to see that academic skill is one of many, equally important abilities we seek in future physicians, which further shows that GPA and MCAT should not be the ultimate yardstick to measure a student’s potential. The frameworks we mention above show that maturity, compassion, and communication style, are just as important as the students’ ability to digest challenging academic material in medical school.
But after the multitudes of changes the medical school admissions process has undergone, have they become better at detecting the competencies we listed? Are they using the appropriate tools?
Application components like medical school personal statements and secondary essays are often presented as opportunities that allow students to tell the story of their journey to medical school, talk about their strengths, uniqueness, and ambitions. Written application components are claimed to allow admissions members to evaluate the students’ cognitive skills and ability to articulate their thoughts on paper. And for most, this insight into the student’s motivations and character would be more informative than simply looking at their transcripts and test scores.
But can essays really demonstrate your suitability for medicine based on the professional competencies we mentioned above? Most written components of the medical school admissions process do not exactly reveal ethical acumen or propensity for compassion. However, they can reveal whether you have taken on leadership roles, how good of a communicator you are, and whether you have a history of health advocacy – which is a lot more than what your grades and MCAT score can reveal. These essays and other short-essay components, such as the AMCAS Work and Activities section, often reveal the students' decision-making processes, their levels of responsibility, communication styles, growth and development, and more. Many of the qualities revealed in essays or activities sections demonstrate the students' commitments and choices they made throughout their academic and non-academic lives.
And while these application components have a better chance of revealing the moral and professional competencies we seek to establish in future physicians than statistics, we cannot deny that there’s also a possibility of bias. As we already mentioned, having time to prepare for your tests and do extra work for your courses, as well as engage in extracurriculars for medical school in a meaningful way is a privilege. Many students are afraid that not having impressive volunteer and health-related work experiences will damage their application – and to some extent, they are right. If you need to keep a part-time job throughout college to pay medical school tuition and feed yourself, then not having enough time to dedicate to extracurriculars can work against you. And while essays and activities sections may be better gauges of motivation and dedication to medical school, they cannot eliminate the existing biases in medical school admissions.
Why Interviews?
Your suitability for medical school is further assessed during medical school interviews. Not only are you expected to think on your feet during weird and intimidating medical school interview questions, but you are also expected to demonstrate moral proclivity during ethical questions in a medical school interview. The new interview formats claim to make the selection process more inclusive. Instead of simply talking about how you would act in a situation or how you would react to an uncomfortable patient encounter, the interviewers can test your reaction firsthand. For example, in Multiple Mini Interviews (MMI), you may encounter acting stations where you will have to take on the role of someone dealing with an angry or volatile individual. Breaking the role may damage your scoring in the interview, so you must do your best to act as you would if such a situation really arose. This is when the interviewers seek to really test your ethical acumen, your values, and your decision-making process. Will you still be kind to an unpleasant patient? Will you try to help or hand the patient off to a supervisor? Will you remain non-judgmental and make the right decision for all involved in the scenario? These are the types of ethical choices the interviewers want to assess in medical school interviews.
However, remember that interview skills are acquired. While the current interview and situational judgment test trends claim to seek out students with inherent professional qualities, it’s important to remember that these qualities can be trained and honed by any individual who wants to do well in the interview. If we continue to believe that these interview formats and tests identify students with professional qualities befitting healthcare that cannot be trained, then we must succumb to the belief that some people are simply not born to become doctors. In other words, they do not meet cultural and socio-economic expectations set up by our healthcare systems. This means that anyone who was raised in a different culture or born in lower socio-economic circumstances cannot be trained to be a doctor. Not only does this affect further bias, but we know that this is preposterous since studies show that many of these qualities are easily coached.
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Conclusion
There is still a lot of work to do when it comes to making the admissions process fair and inclusive. And while the move to go beyond GPA and MCAT is a good direction, the rest of the medical school admissions process should be questioned and scrutinized regularly, because it’s the only way it will improve.
