Mostrando las entradas con la etiqueta Association of American Medical Colleges. Mostrar todas las entradas
Mostrando las entradas con la etiqueta Association of American Medical Colleges. Mostrar todas las entradas

11 abril, 2013

Flexner is shaking

Thought
Thought (Photo credits: www.mysafetysign.com)

Med School Without the MCAT
February 28, 2013 - 3:00am
In a major policy shift, the Icahn School of Medicine at Mount Sinai Wednesday announced that it will fill half of its entering class going forward by admitting college sophomores -- three years before they would enroll in medical school -- and will do so without requiring traditional pre-med course requirements and the Medical College Admission Test (MCAT).
In what a press release called the beginning of a “fundamental shift,” sophomores will be admitted to “FlexMed,” a new program in which they will spend the rest of their undergraduate time in tracks such as  computational science/engineering, biomedical sciences and humanities/social sciences. Students will be encouraged to take courses in biostatistics, ethics, health policy and public health.  These courses would replace the traditional pre-med science requirements.
Students will also be encouraged, but not required, to become proficient in Spanish or Mandarin.
David Muller, Mount Sinai’s dean of medical education, said in an interview that although requirements issues had been “written about for years and years... there’s been either an inertia or a reluctance to take a first step and break down the model and try something new. What I hope will happen is that this program will prove very successful and prove decisively that it’s a viable alternative.”
Mount Sinai has had a similar program on a much smaller scale in the past, and says it has been a success.
Explaining the rationale behind the decision to take a small program and apply it to half of the class, Muller said that pre-med science requirements tend to be “science that is not the most applicable to current clinical or translational research; it’s not unimportant science, but it’s kind of outdated.”
The announcement comes at a time that the MCAT itself is changing in ways that reflect some of the concerns raised by Mount Sinai; last year saw the first major amendments made to the exam since 1991, with a plan to add sections on critical thinking and social sciences.
“I don’t think of the MCAT as something that should be eliminated; I think the efforts to rethink the MCAT are admirable,” Muller said. “[The revision] was a very thoughtful process, and yet the MCAT didn’t eliminate some things that are really not that relevant to medical school. It really just sort of begins to scrape away at the iceberg of what we really need to do.” Muller added that he thinks an over-reliance on the exams has developed. “The use of the MCAT, I think has really been warped over the course of time,” he said. 
Muller also said that the current medical education model fails to take into account changes in the medical and technological landscape. “All of science has changed, even if you went back 50 years,” Muller said. “The science that has had the most impact… is completely different.” For example, Muller said, when he was attending medical school, “the whole concept of information technology didn’t exist… we trained at a time that there was no such thing as a computer that you had [personal] access to.”
Robert Schaeffer, public education director of the National Center for Fair and Open Testing, which has been a frequent critic of the MCAT, and of standardized testing in general, called the move “definitely a step in the right direction.” Schaeffer said that the alteration of requirements “moves Mount Sinai into the national leadership of medical school admissions reform. [The decision] indicates that they recognize the importance of multiple measures to assess for medical school.”
Although he said it was hard to predict the best course of action before any data on the program was in, Muller said that “if we get to the point where we see that there is equivalence between the two groups… we might actually consider increasing it to a larger proportion of the class or the whole class.”
“Medical schools can change their requirements at any time based on their environment and the mission of the institution,” said Geoffrey Young of the Association of American Medical Colleges, which is responsible for the composition and administration of the MCAT. “The AAMC commends innovation in the medical school admissions process.”
“Our hope is that this proves to be a viable alternative to the traditional path,” Muller said. “It’ll really all depend on the data.”
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Holistic Review — Shaping the Medical Profession One Applicant at a Time


Robert A. Witzburg, M.D., and Henry M. Sondheimer, M.D.
April 10, 2013DOI: 10.1056/NEJMp1300411
Comments open through April 17, 2013

Full Text
Modern medicine has been characterized by rapid and accelerating progress in biomedical sciences as the foundation for clinical practice. In 1910, the Flexner Report established these sciences as the core of medical education.1 Admissions committees at U.S. medical schools have, for the past century, focused their attention largely on predictors of success in the foundational science curriculum, relying heavily on academic performance in the biologic and physical sciences and scores on the Medical College Admission Test (MCAT) in selecting applicants for medical school.
Abundant data support the contention that performance in the medical school science curriculum and on the U.S. Medical Licensing Examination (USMLE) Step 1 are predicted by performance on the MCAT and in the undergraduate science coursework required of medical school applicants.2 Key aspects of behavior, character, and performance that are essential for the practice of medicine, however, cannot be predicted from these measures. In addition, performance on standardized tests and in undergraduate sciences is influenced by myriad social, demographic, and economic factors that limit the utility of these measures in large segments of the potential applicant pool for medical school.
Over the past decade, individual medical schools, supported by the Association of American Medical Colleges (AAMC), have been working to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the “holistic review” rubric endorsed by the U.S. Supreme Court in 2003: “highly individualized, holistic review of each applicant's file, giving serious consideration to all the ways an applicant might contribute to a diverse educational environment.” Under such an approach, a school “seriously considers each `applicant's promise of making a notable contribution to the class by way of a particular strength, attainment, or characteristic — e.g., an unusual intellectual achievement, employment experience, nonacademic performance, or personal background.'”3
The AAMC Holistic Review Project has defined holistic review in medical school admissions as “a flexible, individualized way of assessing an applicant's capabilities by which balanced consideration is given to experiences, attributes, and academic metrics . . . and, when considered in combination, how the individual might contribute value as a medical student and future physician.”4
A holistic review process therefore emphasizes attributes, including learning ability, that are associated with excellence in physicians. Applicants are evaluated according to criteria that are institution-specific, mission-driven, broad-based, and applied consistently across the entire applicant pool at a given school. Holistic review does not abandon the assessment of aptitude in science. Rather, it places such measures in the broader context of the applicant's life experiences, with a particular focus on adversities overcome, challenges faced, advantages and opportunities encountered, and the applicant's demonstrated resilience in the face of difficult circumstances. Each factor, be it the undergraduate grade-point average (GPA), the MCAT score, or the leadership roles assumed in volunteer service organizations, is evaluated in the context of the complete portfolio of information available about the applicant. That is, a given level of accomplishment for one applicant may look very different in the context of another applicant with a different life story. Medical schools have many more qualified applicants than they can realistically interview, so holistic principles must be applied from the initial screening through the entire admissions process for their desired effect to be realized.
The imperative for a diverse physician workforce in an increasingly diverse society is one important driver of the move to take a more expansive view of excellence in medical student selection. This more comprehensive approach to considering a multitude of factors in evaluating all applicants provides a context for the inclusion of race, ethnic background, language, culture, and heritage, among other factors, in a way that is educationally sound and legally viable. The AAMC's Experience–Attributes–Metrics Model includes consideration of many dimensions of applicants, broadening the context in which their development, accomplishments, and potential can be evaluated. The metrics include grade trends in addition to the usual GPA and MCAT scores; attributes range from fields of interest, intellectual curiosity, and maturity to languages spoken, gender identity, and family status; and experiences may include everything from education and research to general life experiences.
In 2003, the Boston University School of Medicine (BUSM) became one of a number of U.S. medical schools to launch a systematic transition from a traditional admissions model based largely on the review of academic metrics to a comprehensive, holistic review process. It was a slow and deliberative transition, but by 2008, changes in the BUSM admissions program were clear and substantial, and the effects were evident in the entering class of 2009.
The BUSM Committee on Admissions first developed a mission statement for itself that reflected the concepts in the institutional mission statement and then created a set of decision-support tools using performance metrics, characteristics, and behaviors that are identified in that mission and used in a clearly defined and universally applied manner. The tableMapping Desirable Physician Traits to Applicant Data. shows one such tool: a list of desirable traits for physicians matched with the elements of applicant data that reveal or predict those traits. Direct measures of these traits are often unavailable, so proxies are used. Holistic review is an information-hungry process; electronic processing greatly facilitates both the application and the evaluation of the program. Experiences, attributes, and academic metrics are evaluated and scored in a systematic and consistent manner across the entire applicant pool, with due consideration to the demonstrated validity of various criteria in predicting success in both medical school and medical practice. The BUSM program uses structured interviewing, rigorous training of participating faculty and staff, and systematic evaluation of data elements, all of which minimize the influence of conscious and unconscious bias.
Since BUSM became engaged in holistic review, the profile of its entering class has changed dramatically. Other factors, including changes both at the school and within society at large, have certainly influenced the school's ability to select and recruit strong students, but holistic review is at the core of the process. Students are culturally, linguistically, racially, ethnically, and demographically more diverse than previous classes, and according to the standard measures of undergraduate GPA and MCAT score, they are at least as well prepared academically (the average GPA and average MCAT score were 3.66 and 33.62 for the entering class of 2012, as compared with 3.57 and 31.68 for the entering class of 2008). Students from groups underrepresented in medicine now make up approximately 20% of the entering class, as compared with 11 to 12% before the adoption of holistic review. We observe that students are more frequently engaged in our campus community and in outside activities, and graduating students pursue a broad range of specialties and career paths. The general sense of the faculty, particularly those who teach our small-group problem seminars, is that the students are more collegial, more supportive of one another, more engaged in the curriculum, and more open to new ideas and to perspectives different from their own. Some of these observations are subjective and difficult to quantify, but there is a striking, and uncoached, consensus among the experienced faculty members.
Successful adoption of holistic review in medical school admissions requires a strong commitment by the school, but the process can be bolstered by support from the AAMC's Holistic Review Project, which has nurtured a community of physicians focused on the development and implementation of strategies for ongoing monitoring and improvement.5 This effort is led by a committed group of admissions officers, diversity directors, deans, medical educators, students, and residents from around the country who continue to remind us that medical school admissions is not merely about selecting next year's first-year class, but also about selecting the physicians who will successfully lead a rapidly evolving 21st-century health care workforce.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on April 10, 2013, at NEJM.org.

Source Information

From Boston University School of Medicine, Boston (R.A.W.), and the Association of American Medical Colleges, Washington, DC (H.M.S.).