The MCAT Was a Barrier to Diversity Long Before COVID-19.

Abstract

To the Editor: The COVID-19 pandemic has forced us to renegotiate how we look at medical school admissions through the lens of equity and inclusion. Questions about test center availability and safety led some schools, despite little evidence of test center-related infections, 1 to waive the Medical College Admission Test (MCAT) requirement for the 2021 cycle. 2 Temporarily waiving the MCAT not only fails to acknowledge but also exacerbates the test’s harmful prepandemic effects on racial, ethnic, and socioeconomic diversity. Any decision regarding the MCAT should be substantive and create lasting change to promote the diversification of the medical profession well beyond COVID-19. Many schools with the highest average MCAT scores often have modest levels of diversity in their student bodies, valuing the cost of maintaining stature in U.S. News and World Report rankings over diversity, equity, and inclusion. 3 We must balance the MCAT’s role as a normative keel with our need to open medical school admission to more students from diverse backgrounds. Recent literature demonstrates medical schools accepting students with MCAT scores in the middle third (495–504) increased diversity and that they progressed through their academic program at rates similar to those in the upper third. 3 Because the difference in academic progress varies by 3%–5% between students with MCAT scores in the middle and the upper third (defined by 4- and 5-year graduation rates on the old MCAT and on-time progress year 1 to 2 on the new MCAT), “prestige” is forcing many of our top-ranked medical schools into the bottom quartile for diversity. 3 If COVID-19 redefines our social contract, it should also prompt us to reconsider our relationship with standardized testing. Although holistic admissions can help bridge this moment, a wholesale reconsideration of how we use the MCAT is also necessary. We should evaluate the feasibility of making the MCAT a pass/fail exam, like the United States Medical Licensing Examination Step 1. This is not an effort to eliminate the MCAT but rather to “right size” its importance. By dichotomizing the MCAT into pass/fail scoring groups, we would leave open the door to more multidimensional discussions of what our applicants offer the profession and future patients without sacrificing quality. Until medical training becomes less reliant on multiple-choice assessments, the MCAT will remain a normative marker in medical school admissions. The question becomes: How do we use the MCAT to create the workforce we seek and not just the workforce with the “highest score?”