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The results of this study showed significant differences in MCAT scores between competitive and noncompetitive colleges, but no significant differences between other medical school benchmarks.
Institutional selectivity
During the medical school admissions process, institutional selectivity is used to distinguish students from one another alongside other predictors of academic performance, including MCAT scores and grade point averages (GPAs). [11, 15]. Until now, the use of institutional selectivity may discriminate against applicants with other desirable demographics who earned undergraduate degrees from less competitive schools. For example, students who may not have the financial means to attend competitive undergraduate schools would be at a disadvantage when applying to medical schools that consider institutional selectivity when accepting applicants. Previous research has shown that evaluating schools using the HERI, Barron’s, or Carnegie indices produced no additional benefit in predicting whether medical students would outperform their peers on medical school benchmarks if MCAT scores and unadjusted undergraduate GPAs were available to admissions committees. [11]. Our data indicate that competitive college students who score 511 on the MCAT do as well on medical school exams as noncompetitive college students who score 508 on the MCAT. This may suggest that admissions committees might incorrectly reject applicants who have a 3-point reduction in their MCAT scores, but more information needs to be collected in order to generalize these findings.
Non-numerical indices of success
For many decades, the Association of American Medical Colleges (AAMC) has longed for a more heterogeneous group of physicians in order to treat the vastly diverse population of the United States. [16]. A 2021 publication from the AAMC showed that after excluding historically black medical schools and those located in Puerto Rico from the 155 member schools analyzed, first-year African American medical students increased by 21.0% to reach 2,562, and first-year Hispanic medical students increased. 7.1% to 2,869; First-year Native American or Alaska Native students fell 8.5% to 227 [17]. Currently, there are several challenges in educating and training qualified and compassionate people to be part of the medical workforce, but efforts are being made to combat this problem. [18, 19]. Although traditional predictors, including MCAT scores and GPAs, have a strong correlation with medical school performance, other factors that may have been overlooked could be strong markers of clinical success. Five cohorts of University of Missouri-Columbia students were analyzed by admissions investigators and found to have high levels of maturity, non-academic achievement, medical motivation, and rapport. All of these personal characteristics proved to be beneficial as these individuals were 2-3 times more likely to receive outstanding internship recommendations compared to those who did not possess these characteristics. Undergraduate GPAs had a smaller but still significant relationship with clinical success as measured by internship letters [20]. This indicates that clinical success, which is one of the fundamentals of medical school, can be predicted more strongly using unconventional factors.
Courage is the tendency to maintain interest and effort towards very long-term goals. People who possess courage tend to be more controlled, referring to regulating attention, emotions, and behavior when important goals conflict with immediately pleasurable temptations. [21]. Angela Duckworth and her colleagues were able to develop a scale of 8 and 12 items to assess an individual’s courage. Although Duckworth discourages the use of these scales in high-stakes situations such as admissions, she emphasizes that these scales matter when aggregated with several other measures of success. In 2005, several self-mastery studies were pooled, including a gratification delay task, self-report, teacher-report, and parent-report questionnaires, concluding that a composite score for mastery predicted final report card grades better than standardized measures of cognitive ability [22]. Therefore, we believe that applying a courage assessment tool in the medical school admissions process can be a complement to the holistic review.
holistic review
To minimize the impact of individual biases, a large pool of faculty reviewers could be put in place. At The Ohio State University College of Medicine (OSUCOM) circa 2009, the initial screening process was conducted by only two people: a staff member and the associate dean of admissions. [19]. Having too few screeners could result in a large number of qualified candidates not being invited for an interview due to implicit biases. For example, if there are only two examiners and one is biased against applicants with little clinical experience, all applicants who fall into that category will be at a disadvantage. So will racial, ethnic and gender bias. However, if several people are involved in the selection process, the impact of their individual biases will be reduced. Therefore, a total of sixty examiners have been trained each year to holistically review applicants (as defined by the AAMC), avoid implicit biases, and select individuals who are a good fit with the medical school’s mission. [16]. By using a larger pool of trained faculty members, we believe that any implicit emphasis previously placed on institutional selectivity can be mitigated during the selection process.
The adoption of a holistic examination should also play an important role in the analysis of student achievement. The AAMC Holistic Review in Admissions project calls for giving equal weight to an applicant’s experiences, personal qualities, and academic parameters. [23]. Although there may be some hesitation in supporting a system that minimizes academic metrics, our results show that the MCAT is the only accurately predicted exam score based on undergraduate institution selectivity. Although intellectual achievement as measured by the MCAT is important in evaluating medical school applicants, the holistic review allows academic measures to be a contributing factor rather than a primary one. KKSOM students who attended non-competitive colleges had an average MCAT score of 508 while those who attended competitive colleges had an average MCAT score of 511. Therefore, students whose MCAT scores were significantly lower than their counterparts who were attending a more competitive college could potentially be accepted score does not impede performance on future medical school benchmark exams, and if their experiences and attributes are clearly outstanding. Paradoxically, OSUCOM found that by changing the academic parameters to have less importance during the admissions process, their MCAT class average increased, a finding also demonstrated at Boston University School of Medicine. [19, 24]. Additionally, Cathcart-Rake et al. showed that students accepted into a rural regional medical school with MCAT scores significantly below the average of all US allopathic medical schools were able to significantly improve their USMLE Step 1 and USMLE Step 2 scores above what was predicted from their MCAT scores [25]. This reinforces the feeling that numerical indices and institutional selectivity are important, but only when analyzed within a larger framework that assesses students holistically.
Admissions committees have access to a wide range of information about incoming applicants, including their GPA and MCAT scores as well as their personal statement, professional photo, and undergraduate college attended. [26]. A 2012-2013 study at Ohio State University College of Medicine (OSUCOM) demonstrated significant implicit racial bias with white preference after administering the Implicit Association Test (IAT) to 140 members. [27]. This finding is extremely limiting and may limit medical school acceptance rates among underrepresented minorities, which ultimately impacts patient care. When trying to increase objectivity among medical school admissions, one solution to reducing bias is to ensure that investigators and admissions committees do not know the undergraduate institution of a candidate. Because our results demonstrated that NBME Phase 1, USMLE Step 1, NBME Phase 2, and USMLE Step 2 scores were not statistically significant between groups of KKSOM students, we wonder why this information was included for teachers to see. If a student were theoretically required to attend an admissions committee member’s alma mater, this could positively impact their admissions decision. Conversely, if a faculty member has a bias toward community colleges, it could negatively impact a student’s ability to attend medical school. Above all, equity must be valued when discussing future candidates to advance diversity, equity and inclusion.
Limits
Our findings were based on data collected from single institutions, so multi-institutional analyzes should be conducted in the future to determine whether these findings are institution-specific or representative of all medical schools. Our definition of a competitive undergraduate institution may not be identical nationally, reducing the ability to generalize our results if other studies use different grouping criteria. Cohort data from the 1997 National Longitudinal Survey of Youth showed that a multifaceted index of college quality can provide a more comprehensive approach to identifying competitive colleges. They include the average SAT scores of incoming students, the percentage of rejected applicants, the average salary of all faculty engaged in teaching, and the faculty-student ratio to determine the college’s competitiveness. [27]. Finally, our research model ends after monitoring USMLE Step 2 exam performance. Future research should dig deeper into physician careers and analyze the impact of institutional selectivity on residency match rates.
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