Robert C. Bowman, M.D.
You have given me a chance to sharpen my wits in this area, as the perception of weaker candidates is a key area that I must address.
As a father of 2 ADHD children and another who is a likely ADHD plus learning disabled, I do not look at my children or any like them as weaker or impaired, just wired differently and with different gifts and different challenges.
As an urban born person who has lived in urban and rural areas and has seen attitudes and behaviors of both, I do not look at urban lifestyles or rural as better or worse, just different from each other and different that other areas as well. I certainly do not hold rural areas to have a "paucity of culture" as some national medical leaders have stated publicly as a reason that doctors do not go to rural areas.
As a physician who has cared for a number of patients who are extraordinary, I look at them as different, not weaker. My highest admiration is for many of them that continue to exist and even thrive despite not having the things that we all seem to value far too much in our society.
I do not look at family medicine as weaker, just different. It has taken me years to work out of the feeling, taught to me at every turn that family medicine was weaker. Only having a mom who was an RN for FP docs kept me from believing it too much to choose FP. Sadly many still believe that FP is weaker, often those who are providing the most service and have so much more to offer as teachers and leaders.
As health advisors, I doubt whether most of us think of a point or two of MCAT as making a student weaker or not, just different and perhaps more challenged. Is a student working a job and having a family with a 3.4 and 8.6 MCAT "weaker" than those admitted? Especially when coming from less quality K-12?
Some of the gifts that make a student an easy medical school admission actually may impair their development as a family physician, public servant, etc. It is the rare individual that has incredible intellect and superior personal and people skills. In many ways intellect makes it more difficult to develop other skills. Those without tremendous intellect have to rely on other areas, much as a blind person develops other senses. The full range of skills that would make an excellent physician involve many areas, and by far the minority is tested and evaluated in today's admissions. I think that this is another reason why admissions seems so unpredictable in medical schools. Some of the areas include:
A. People relationships - the basis of any health professional directly involved with patients. Sadly physicians are less directly involved with patients.
B. Community/societal/teaching relationships - able to integrate the concepts of science and technology with affordability, practicality and take health care out of the office and into the family and the real world, especially public health areas
C. Administrative expertise - ability to manage people and resources
D. Personal discipline - vastly important for those starting with low financial assets and educational challenges, especially if not gifted with the 10 + speeded intellect, sadly much less important for those with the high intellect, and a source of problems for health care.
E. Intellectual, not speeded intellectual, but ability to integrate concepts - MCAT and GPA touch on these
F. Emotional intelligence, ability to adjust, self motivate, - interview and letters are a small measure of this
G. Kinesthetic ability, particularly in certain types of physicians likely other areas
Personal integrity, trust, etc. - Talk about a good candidate for threshold measurement, this is it. Without this, there should be no admission at all. Beyond the confidentiality and the ability to defer self interest in favor of needs of patients, is also the fact that if we as a society do not trust physicians, there will be no end to health care costs - another of today's problems
Students who have had to overcome significant obstacles due to birth origin and family and other reasons that have nothing to do with them as individuals, have often had to develop and demonstrate many if not all of these non-intellectual skills to make it, especially if they are less gifted in a single intellectual measurement on a certain day
What we test for in class, in education, and in medical education, is what we work to change and improve. AAMC knows this as much or more than any. The AAMC GQ has continually shaped medical education. New questions appear and medical schools get feedback and compare and change their ways, and medical education improves. One of the things that I like about admissions in some schools, is that they give feedback to students that gives them a target area to improve. When students return and have clearly addressed the areas in question, it is very hard not to work with them.
When we test only the intellectual, and indeed, the speeded intellectual skills, we are likely to be missing out on many other areas as important or more so. When a test does not discern clearly between weaker and stronger physicians, it should be given less of a role, especially at a time when other pressures tend to force use of less time-intensive methods of evaluation. Without the MCAT, I suspect that admissions committees would have to spend more time and effort with admissions, and might do a better job. This does not mean that it is not a good tool however, it is the dependence that we have developed on it that has become a problem.
As people we deserve the best physicians. We all want the best health care that we can have. As a nation we want high quality readily accessible health care. We cannot afford what we have currently, partly because we are unwilling to invest in education, advisement, evaluation, and better medical education. This includes improved selections. Our current system is too expensive and is eroding into education and other societal needs and into the needs of other developing nations.
We pay now, or we pay much more later, in lots more ways than we can ever imagine.
We have to improve selections for medical school and we must attract students who have a broader and better array of skills than we currently have. Medical schools far too often believe that they can change an adult into something else. This is one of the great myths that Family Medicine and Primary Care subscribe to. A different view is that many of the most desirable skills are given at birth and through situations and environments long before medical school. Even the perceived incredible stress of medical school is not likely to remold an individual in a significant way.
Robert C. Bowman, M.D. rcbowman@atsu.edu
PS - The Bible also makes some pretty good arguments of how weaker is better.