A page from the first Medical College Admission Test (MCAT) administered by the AAMC. (1947). Source: AAMC Reference Center, https://www.aamc.org/who-we-are/aamc-history.
Any prospective medical student must dedicate hours of their life studying for the infamous MCAT, but the origins of the test and the changes to it over time are not usually the first thing potential test-takers learn about. The Medical College Admission Test was developed in 1928 to address a very serious problem: an alarming attrition rate of 5 to 50% in medical schools across the country.1 Created at a unique moment when scientific rigor and quantitative approaches were increasingly applied to measure mental aptitude, the test was intended to determine intellectual ability to make it through medical school. Although the test has changed form over the years, its fundamental assumption remains the same, that “academic aptitude is similar, if not identical, to common conceptions of intelligence.”2 Recently, as colleges and universities across the country have begun to question the actual value of standardized testing, from reducing or eliminating the need for SAT or ACT scores to the American Bar Association debating ending law school requirements for the LSAT, the structure and testing capacity of the MCAT has been increasingly called into question.
“Students at US medical schools in the early decades of the 20th century had attrition rates of 5% to 50%, which represented a huge waste of human capital, individual and family aspirations, faculty time and energy, and misspent tuition money. Thus, the MCAT was created to better evaluate medical school applicants’ readiness for professional education… Through its 74-year history, the various renditions of the MCAT demonstrate that the definition of aptitude for medical education reflects the professional and social mores and values of the time.”
Dr. William C. McGaghie, “Assessing Readiness for Medical Education: Evolution of the Medical College Admission Test,” 2002.
Concerns over the MCAT as a Predictor of Success
Over the twenty year period between 1997 and 2017, the national attrition rate was relatively stable at an average of 3.2%.3 In that regard, there is no doubt that the MCAT has helped solve the problem it was created to address. The national average attrition rate is far lower now than it was in 1928. In the present day, the main concern over the MCAT has been whether the test is actually a good indicator of preparedness for medical school. One empirical study from 2015 indicated “that the MCAT scores were not reliable predictors of OSCE or PGY-1 performance,” pointing out that “the MCAT was not designed to be a test of skill or professionalism.”4 The MCAT did demonstrate weak correlation with performance on knowledge-based assessments, especially multiple-choice tests, but did not indicate how a student would perform on assessments on patient interaction.5 The conclusion of this particular study emphasizes that the MCAT is but one of many tools that medical schools should use to select students, and by no means is a perfect indicator of academic and career success.
“It may be that good MCAT scores are simply a surrogate marker for one’s ability to navigate our educational system as it is currently constructed.”
Aaron Saguil et al, “Does the MCAT Predict Medical School and PGY-1 Performance?” 2015.
In recent years, long-standing issues over racial inequality in standardized testing have begun to be addressed. There are valid concerns over racial disparities in scores achieved, especially given the evidence that the scores alone may not indicate the full picture of how prepared a student may be for medical school. What should be the goal of standardized testing for medical school? If it is to purely test academic skills, then there must be an understanding that this form of testing will inherently provide higher scores to those who had more resources during their education, i.e. access to tutors, access to MCAT prep. Even simply the access to high-quality elementary and high school education will have long-lasting effects on an individual’s ability to score highly on standardized tests.
Some critics of the current MCAT argue for a pass/fail standard to be implemented “to remove barriers for disadvantaged minority applicants, while still ensuring that students are prepared for medical school.”6 Other experts put forward a more nuanced approach, suggesting that concepts such as “distance traveled” be used as “factors in the admissions process to create a more diverse cohort of students along racial, class, and gender lines without compromising quality.”7 Distance traveled is a term that describes how “students’ family backgrounds impact their education attainment, occupational status, income, and wealth capacity.”8 To achieve the same level of success, a student from a lower socioeconomic background will have had to overcome more obstacles to reach the same point as a more privileged student. For example, a first generation college student attaining a Bachelor’s degree has traveled further from their social class origins than a student whose parents both graduated college. It is unlikely that the MCAT itself will evolve to include such evaluations of distance traveled or other soft skills like perseverance, but medical schools have been more inclined in recent years to expand the breadth of factors they consider for admittance. Factors like this may be viewed more rigorously in addition to traditional means like the MCAT.
It is also possible that more permanent changes may be made to the MCAT, like removing it as a requirement for medical school entirely. Other standardized tests are experiencing major changes to their importance to admissions. Since the pandemic, many undergraduate colleges have removed the SAT and ACT as requirements for admission. Even The American Bar Assocation is currently embroiled in a debate on whether to eliminate the LSAT as a requirement to enter law school. The concerns of that debate are similar: those who want to end the requirement argue “that the LSAT is a flawed measure and a barrier for minority would-be lawyers because on average they score below white test-takers.”9 The other side is concerned that eliminating the test “would make admissions offices more dependent on subjective measures such as the prestige of an applicant’s college,” which would disadvantage minority applicants.10 Inevitably in response to changing needs and values, the MCAT will similarly change in both importance and form over the years. Perhaps it will change to a pass/fail test as suggested by some, take on another form entirely, or be phased out as a requirement.
The MCAT was created in response to alarming attrition rates from U.S. medical schools, which constituted a huge waste of both human efforts and money. Certainly, the MCAT has improved attrition rates, which are far lower now than in 1928. However, the current goal of the MCAT is to assess whether the applicant is prepared for medical school and aims to be a predictive tool for how well they will perform once they are accepted. Data has suggested that the MCAT does not reliably correlate to performance in medical school and may simply indicate one’s ability to navigate the current education system. The MCAT will continue to evolve over the years to fit changing needs and concerns, but in the meantime, any prospective medical student must understand the test and study hard for it.
To prepare for the MCAT, talk with your school about potential prep courses or tutoring. Other resources include https://www.khanacademy.org/test-prep/mcat, a test prep course maintained with the support of the Association of American Medical Colleges (AAMC), and https://students-residents.aamc.org/prepare-mcat-exam/prepare-mcat-exam, a collection of resources about the MCAT from the AAMC.
Thank you for reading,
1. McGaghie, William. “Assessing Readiness for Medical Education: Evolution of the Medical College Admission Test.” JAMA: The Journal of the American Medical Association 288, no. 9 (September 2002): 1085-90. doi:10.1001/jama.288.9.1085.
2. McGaghie, “Assessing Readiness.”
3. AAMC. “Graduation Rates and Attrition Rates of U.S. Medical Students,” October 2022. https://www.aamc.org/media/48526/download.
4. Saguil, Aaron, Ting Dong, Robert Gingerich, Kimberly Swygert, Jeffrey LaRochelle, Anthony Artino Jr., David Cruess, Steven Durning. “Does the MCAT Predict Medical School and PGY-1 Performance?” Military Medicine 180, no. 4S (April 2015): 4–11. doi:10.7205/milmed-d-14-00550.
5. Saguil et al. “Does the MCAT Predict.”
6. Hammond, Alessandro and Cameron Sabet. “Opinion: Med schools should de-emphasize standardized admissions tests.” washingtonpost.com. December 7, 2022. https://www.washingtonpost.com/opinions/2022/12/07/mcat-medical-schools-diversity/.
7. Ray, Rashawn and Joey Brown. “Reassessing Student Potential for Medical School Success:
Distance Traveled, Grit, and Hardiness.” Military Medicine 180, no. 4S (April 2015): 138–141. doi:10.7205/milmed-d-14-00578.
8. Ray, “Reassessing Student Potential.”
9. Sloan, Karen. “ABA pauses move to nix LSAT requirement.” reuters.com. May 12, 2023. https://www.reuters.com/legal/government/aba-pauses-move-nix-lsat-requirement-2023-05-12/.
10. Sloan, “ABA pauses move.”