Cohen on Admissions
Key Concept: "No matter how successful we are in attracting idealistic,
properly motivated students to medicine now or in the future, we have little
hope of delivering the same number of idealistic, properly motivated doctors to
society unless we can close the gap between rhetoric and reality." Dr. Jordan J.
Cohen
Time to Address Current Realities within Medical Education
"But before we address misperceptions about the distant future of medical
practice,
we must address some current realities within medical education itself --
realities that
I fear are also dissuading many promising college students from seriously
considering a
career in medicine. The first is the way we select students for admission to the
profession, and the second, and even more important, is the way we acculturate
the
students we do admit to become professionals by the time they finish their
formal
education.
The Admissions Process
"What about the way we pick students for admission? My concern here is the
imbalance that currently exists in how we convey to applicants the selection
criteria
we use. I'm referring, of course, to our tendency to under-emphasize, because
they
are harder to measure, the personal characteristics we are seeking in our
applicants,
and to over-emphasize the more easily measured indices of academic achievement."
"I know how tough this issue is. And please don't misunderstand me; in no way am
I
suggesting that native intelligence and academic prowess are anything less than
essential for success in medical school, or for becoming an effective physician
or
scientist. What I am suggesting, however, is that our admission processes do not
project to prospective applicants the degree to which we value, in addition to
GPAs
and MCAT scores, those other essential attributes we prize: altruism, fervor for
social
justice, leadership, commitment to self sacrifice, empathy for those in pain."
"That many idealistic students do make it through the process, despite the
distorted
signals we send them about what we are looking for, is no guarantee that
sufficient
numbers will continue to do so going forward. If more such intelligent and
dedicated
idealists were to perceive that we would give as much weight to what's in their
hearts
as to what's in their heads, a career in medicine would no doubt attract them
strongly.
As it is, I'm persuaded that many don't perceive this balance in our selection
criteria,
and turn away convinced that medicine is for grade-grubbing Philistines but not
for
them."
"To balance the strong message we send about the importance of grades and test
scores with more visible evidence of our co-equal interest in humanistic
attributes, let
me offer six ideas for you to consider:
"1. Use MCAT scores and GPAs only as threshold measures. Rather than giving more
weight to higher scores, why doesn't each school decide for itself, from data
available
from its previous students, what level of GPA and MCAT performance is sufficient
for
predicting success in clearing the high academic hurdles of medical school --
and leave
it at that. We would send a powerful signal to those intelligent idealists who
are
currently eschewing medicine if they knew that, once having met the academic
achievement threshold, they would be evaluated solely on the basis of their
humanistic
qualities, their penchant for serving others, their leadership abilities, and so
on.
"2. Even more daring, how about beginning the screening with an assessment of
personal characteristics and leave the GPAs and MCAT scores 'til later. Rather
than
looking first for reasons to reject an applicant -- like evidence of a
lackluster start in
college, or a bad semester, or a C in an organic chemistry, or a "7" on an MCAT
subtest -- why not look first for reasons to accept an applicant - like evidence
of
deep-seated social awareness, of having triumphed over adversity, of personal
sacrifice for the benefit others - and only then consider the statistical
predictors of
mastering our challenging curriculum. Approaching their task in this way,
admission
committees might well find many instances in which truly compelling personal
characteristics would trump one or two isolated blemishes in the academic
record.
"3. Look even more favorably than you do now on the more mature applicants,
those
who chose some other field at the end of college, but who awakened several years
later to medicine as their true calling. Such students often manifest a depth of
motivation that not only predicts success as future physicians, but also
provides
inspiration to their fellow students.
"4. Stop using the average MCAT scores and GPAs of our matriculants as if they
were
valid measures of the relative quality of our schools. Take a look at the
devastating
critique of the U.S. News & World Report's rankings of the "best" medical
schools in
this month's Academic Medicine and see if you don't agree with what the authors
have
to say. In accepting without objection the use of such misleading measures as
average MCATs and GPAs, let alone in ballyhooing them in our own promotional
materials, we reinforce the public perception that they are, indeed, our
principal
criteria for admission.
"5. Use past experience to improve our ability to spot the truly outstanding
prospects.
As a general rule, it doesn't take long for a consensus to emerge among faculty
and
staff about who among each entering class of students are destined to be the
best,
most caring, most compassionate physicians. They are the ones who win the
humanism awards, who tutor their classmates, who are elected class
representatives,
who are the pacesetters for student-initiated community service activities, and
so on.
Why don't we look back at those students' credentials at the time of admission
and
see if we can find some common characteristics that might be helpful in
sharpening our
ability to identify such stars among future applicants. And let's use even more
of those
star students as recruiters and as full-fledged members of our admission
committees.
"6. Help us devise better tools for evaluating students' personal
characteristics. It's
too easy to assume that the so-called soft qualities we're looking for are
beyond our
ability to assess any more accurately than we do with our present crude
measures. I
just don't believe that. But we'll never know for sure unless we try. For
starters, I
have directed the AAMC staff to see what we can do to develop better tools, and
I
urge all of you to give thought to this tough problem. Not only because we may
actually succeed in improving our selection process, but also because there are
surely
many more dedicated and intelligent idealists out there who would recognize our
efforts to seek better measures of character traits as a strong signal that we
want
them as colleagues."
Jordan Cohen
www.ruralmedicaleducation.org