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Implications of the MCAT Changes for Other Health Professions

Medical education has traditionally assumed a major leadership role in health professions education, and there is no doubt that innovations in medical education have had substantial influence on other units of the campus, especially in the academic health center. The environment in health professions education and healthcare is changing dramatically and rapidly, however, in ways that would have been unimaginable even a decade ago. Medicine still retains its substantial influence, but these changes provide an opportunity to develop a healthcare workforce that will provide for care that is delivered by a team of healthcare professionals working at the full scope of their education, training, and licenses. The new Medical College Admission Test (MCAT) will force changes in the preparation and expectation of students applying to medical school, but the new test will also have a collateral impact on students applying to other health professions as well. Through this article, I hope to provide a perspective on the implications that the new MCAT will have on other health professions.

The New Healthcare Environment: A Sense of Urgency

The recent political focus on the Patient Protection and Affordable Care Act of 2010 (PPACA) has overshadowed many of the changes that are occurring in healthcare that are actually independent of the implementation of the new law. There is substantial healthcare reform already underway. The market is becoming more dominated by large healthcare systems such as United Healthcare and Kaiser Permanente, which are able to control the roles that healthcare providers play in these corporations. The number of physicians employed by these systems has increased significantly in recent years. Now there is a focus on collaborative practice that is being delivered more frequently in community-based settings. A number of recent reports, such as the IOM Future of Nursing Report (Institute of Medicine 2011) and the Lancet Commission Report (Frenk et al. 2010) on transforming health professionals’ education, highlight the compelling need for more interprofessional approaches to interprofessional education and practice. There is a recognized need for health providers to be lifelong learners and critical thinkers who can address the needs of patients with an intellectual curiosity over a career and not by rote memory of facts and practices that were contemporary at the time of their entry into practice. The future of collaborative healthcare practice will require that all of the members of the team have the same competencies in the basic foundations of healthcare that are expected of physicians. The change in the MCAT and its consequences on the college and university curriculum that prepares students for the test will affect students preparing for careers in other health professions as well.

Moving from Prerequisite Courses to Competency-Based Assessment

The basis for much of the change leading to the revised MCAT extends from two recent reports on the foundations of preparing future physicians. The first one, Scientific Foundations for Future Physicians, is a report of a committee of representatives from the Association of American Medical Colleges and the Howard Hughes Medical Institute (Association of American Medical Colleges–Howard Hughes Medical Institute 2009). This report emerged “largely from the concern that premedical course requirements have been static for decades and may not accurately reflect the essential competencies every entering medical student must have mastered, today and in the future.” The report then goes on to focus on the competencies that are required in the premedical curriculum, and makes the case for the ways in which the MCAT should be used to assess these competencies. The second report, Behavioral and Social Science Foundations for Future Physicians, identified those competencies that an entering medical school student should have in the behavioral and social sciences (Association of American Medical Colleges 2011). As the report states, “A complete medical education must include, alongside physical and biological sciences, the perspectives and findings that flow from the behavioral and social sciences.”

These reports represent bold transformations of the expectations of the competencies of incoming medical students. Not only is there now to be a focus on gaining competencies, as opposed to mastering a set of prerequisite courses, but the areas of education and experiences are expanded much more significantly into the behavioral and social sciences. In equal measure, these documents form the foundation for changes in the academic preparation of students whose career aspirations are in other health professions. Whether a college student pursues a career in medicine, dentistry, or another health profession, these competencies are critical to his or her future success. Most of the other major health professions have undergone similar transformations in their approaches to competencies and curricular reform. In the dentistry profession, for example, our association has adopted a set of “ADEA Competencies for the New General Dentist” (American Dental Education Association 2008), which includes new competency domains in critical thinking, professionalism, communications, and interpersonal skills, in addition to the more traditional competencies of patient care, health promotion, and practice management. We also have an established an ADEA Commission on Change and Innovation in Dental Education to provide a national forum to address issues of contemporary issues in curricular design and reform (Kalkwarf, Haden, and Valachovic 2005).

A Collaborative Academic Approach to the Changing Healthcare Environment

The traditional focus on premedical education in colleges and universities, and the primary roles that physicians have commonly played in the healthcare delivery system is undergoing a dramatic and comprehensive review. As healthcare reforms begin to be implemented, either because of government intervention or economic necessity, there is a concerted effort underway to rethink the concept of collaborative approaches to healthcare delivery and the education of all health professionals. In 2009, six organizations representing schools of health professions began a process to develop basic competencies for interprofessional education, with support from three private foundations. Two reports were then released that recommended these new competencies and action strategies to implement them in institutions across the country. The intention of these strategies is to transform the current healthcare system to provide collaborative, high-quality, and cost-effective care to better serve every patient.

The first report, Core Competencies for Interprofessional Collaborative Practice, was produced by an expert panel convened in 2009 by the Interprofessional Education Collaborative (IPEC), a unique partnership of six associations (see fig. 1) representing academic institutions in dentistry, medicine, nursing, osteopathic medicine, pharmacy, and public health (Interprofessional Education Collaborative Expert Panel 2011). Interprofessional education, as defined by the World Health Organization, involves shared learning among students from two or more health professions. The panel identified four domains of core competencies needed to provide integrated, high-quality care to patients within the nation’s current, evolving health care system (see fig. 2). It also identified thirty-eight specific subcompetencies that describe the essential behaviors across the four domains. The second report, Team-Based Competencies: Building a Shared Foundation for Education and Clinical Practice, was the result of a 2011 conference, brought together leaders from various health professions to preview the core competencies presented by IPEC, and create action strategies that would use them to “transform health professional education and health care delivery in the United States” (Macy Foundation 2011).

Figure 1. the Interprofessional Collaborative (IPEC)

  • American Association of Colleges of Nursing
  • American Association of Colleges of Osteopathic Medicine
  • American Association of Colleges of Pharmacy
  • American Dental Education Association
  • Association of American Medical Colleges
  • Association of Schools of Public Health

There has subsequently been considerable activity on the interprofessional education front. The chief staff officers of the members of the IPEC meet on a regular basis to address common issues across the professions. Two faculty development institutes are being held in 2012 to bring together representatives of different professional schools at nearly one hundred academic health centers to enhance cross-campus collaboration and the implementation of the curricular and logistical changes required to transform independent academic programs into a true interprofessional approach to educating future health professionals. The Institute of Medicine (IOM) is now in the middle of conducting a multiyear set of workshops through the IOM Global Panel on Innovations in Health Professional Education (Institute of Medicine 2012). As more schools of the health professions adopt an interprofessional education approach, the more likely it is that the curricular changes that may result from the implementation of the new MCAT will impact other health professions as well.

Figure 2. IPEC Recommendations for Future Health Professionals

The IPEC panel recommends that the future health professional be able to

  • assert values and ethics of interprofessional practice by placing the interests, dignity, and respect of patients at the center of health care delivery, and embracing the cultural diversity and differences of health care teams;
  • leverage the unique roles and responsibilities of interprofessional partners to appropriately assess and address the health care needs of patients and populations served;
  • communicate with patients, families, communities, and other health professionals in support of a team approach to preventing disease and disability, maintaining health, and treating disease;
  • perform effectively in various team roles to deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable.

 

College and University Students Preparing for Careers in the Health Professions

It is always a challenge to identify the size of the cohort in colleges and universities that are preparing for a career in medicine or one of the other health professions. There is abundance of health professions that are recruiting students into their academic programs, some of which require only a few months of postsecondary education and some of which require ten or more years of postsecondary education. If we consider only those eight professions that generally require a professional doctoral degree for initial licensure, there are 50,000 first-year slots (see fig. 3) for these students in the respective US health profession schools. If we assume that there are about two applicants for every first year slot in these professions, then there are about 400,000 college and university students throughout the four years of the prebaccalaureate student body in the United States. As large as this number is, it considers only those students preparing for these eight health professions, and does not consider those preparing for advanced-level degrees in such professions as nursing or physical therapy.

Numbers of First-Year Slots (2012–2013, Approximate)

Figure 3. Health Professions Generally Requiring a Professional Doctoral Degree for Initial Licensure

Chiropractic

2,500

Dentistry

5,300

Medicine

19,250

Optometry

1,738

Osteopathic medicine

5,.900

Pharmacy

13,500

Podiatric medicine

680

Veterinary medicine

3,000

The implications of the MCAT changes need to be considered for their impact not only on premedical students, but also on this large number of students preparing for careers in the health professions other than medicine. The changes in the MCAT are intended to prepare individuals to have a more rounded college experience that will result in more compassionate physicians with skills in critical thinking and lifelong learning. Whatever changes are made to the college curriculum to prepare these students will impact students considering other health professions as well. This is generally perceived as a positive event for all students in the health professions, as we hope to prepare all students for the same changes in the healthcare system, and the same attributes are expected for all providers of healthcare in the future. These common attributes will be critical to ensuring that the future of team-based, collaborative healthcare is realized.

The Key Role of College and University Advisors for the Health Professions

The National Association of Advisors for the Health Professions (NAAHP) represents the college and university faculty and administrators who advise students preparing to apply to medical schools and to schools of other health professions. Traditionally, they were often referred to as the “premed” advisors, as their focus often was on working with applicants to medical school in what was seen as a highly competitive environment. As other health professions have become more attractive as career choices, these advisors have generally become much more amenable to providing equivalent advising support for students preparing for other health professions. In articles that have appeared in The Advisor, the journal of the NAAHP, concern has been expressed about the direction that the revised MCAT will take in moving to a focus on competencies rather than courses, the challenges that non-science majors will have in meeting the competencies, and the impact that the revisions will have on colleges and universities in meeting the expectations of the MCAT revisions (Begley et al. 2011). These concerns are appropriate and are sure to lead to further dialog between the advisors and the medical education community. From the perspective of other health professions, this may actually be a desirable outcome of the process leading to the revised MCAT. The traditional approach to preparation for medical and most other health professions schools—satisfying a list of perquisite courses—is unlikely to provide the opportunity to assess the competencies of a prospective applicant to meet the demands of tomorrow’s health care providers.

Standardized Tests and the Concept of “Holistic Admissions”

It is generally accepted that standardized tests, such as the MCAT and the dental equivalent, known as the Dental Admissions Test (DAT), have a clear role to play in the evaluation of applicants to various educational programs, but these tests are mostly predictive of first-year success and not necessarily much further beyond the first year (Sackett, Borneman, and Connelly 2008; Shultz and Zedeck 2011). While these standardized tests are valuable in the assessment of applicants, the question routinely arises regarding the weight that these tests should be given in the final consideration. Most schools of the health professions could accept a scientifically qualified class of new students simply by taking those applicants with the highest overall GPA, the highest science GPA, and the highest MCAT or equivalent admissions test scores. These students will likely perform well in the basic sciences and may actually perform well in the clinical sciences. But are they most likely to become the healthcare providers with the competencies needed to provide the most compassionate and contemporary care in the future? This is especially a concern for those applicants from underrepresented minority and educationally disadvantaged backgrounds who may become future leaders in the health professions, but whose early academic preparation might not provide them with the skills needed to be successful test takers.

There has been an effort in recent years to reassess the way in which many health profession school applicants are assessed that takes multiple attributes into account that are well beyond those provided by college GPA and standardized test scores. This new approach, often referred to as “holistic admissions” or “full-file review,” provides evaluators with much more information about an applicant’s life experiences and competencies that go well beyond test scores. The Association of American Medical Colleges’ Holistic Review Project is a program that uses workshops directed at medical school admissions committees go beyond academic indicators of success and also to take personal factors into account when evaluating minority applicants. At the American Dental Education Association, with funding from the Robert Wood Johnson Foundation, we have initiated an Admissions Committee Workshop program designed to enhance the ability of committees to assess applicants through a more holistic approach. Through pre- and post-workshop surveys of participants, we have been able to demonstrate success at improving the evaluation of applicants to dental school (Price, Wells, Brunson, Sinkford, and Valachovic 2011). While the process of introducing revisions to the MCAT has become the focus of considerable work of many individuals in medical education and in colleges and universities, it is essential to remember that standardized tests are valuable in assessing applicants to schools of the health professions, but that there are many other nonacademic factors that are also valuable in the assessment of an applicant.

Conclusions

The revisions to the MCAT are important steps in a much more substantial overall reassessment of the appropriate competencies for applicants to medical school and the way in which the test can assess those competencies in an appropriate way. The impact of the revisions is manageable and should improve the curricular offerings in colleges and universities that prepare students for medical school. These steps are important for all of us in the health professions. The competencies of future physicians that are driving the revisions are the same competencies that will be required of future dentists and other health professionals.

References

American Dental Education Association. 2010. “ADEA Competencies for the New General Dentist.” Journal of Dental Education 74 (7): 765–768.

Association of American Medical Colleges. 2011. Behavioral and Social Science Foundations for Future Physicians. Washington DC: Association of American Medical Colleges.

Association of American Medical Colleges–Howard Hughes Medical Institute. 2009. Scientific Foundations for Future Physicians. Washington DC: Association of American Medical Colleges and Howard Hughes Medical Institute.

Begley, G. S., DeMasi, J., De Souza-Hart, J., Reichard-Brown, J., and Thurlow, D. L. 2010. “Medical Competency and Premedical Curricular Dialogues in Atlanta.” The Advisor 30 (3): 5–13.

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

Frenk, Julio, L. Chen, Z. A. Bhutta, J. Cohen, N. Crisp, T. Evans, H. Fineberg, et al. 2010. “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World.” The Lancet 376 (9756): 1923–1958.

Institute of Medicine. 2012. http://www.iom.edu/Activities/Global/InnovationHealthProfEducation.aspx (accessed October 10, 2012).

Interprofessional Education Collaborative Expert Panel. 2011. Core Competencies for Interprofessional Collaborative Practice. Washington, DC: Interprofessional Education Collaborative.

Kalkwarf, K. L., N. K. Haden, and R. W. Valachovic. 2005. “ADEA Commission on Change and Innovation in Dental Education.” Journal of Dental Education 69 (10): 1085–1087.

Price, S.S., A.Wells, W. D. Brunson, J. C. Sinkford, and R. W. Valachovic. 2011. “Evaluating the Impact of the ADEA Admissions Committee Workshops.” Journal of Dental Education 75 (5): 696-705.

Sackett, P. R., M. J. Borneman, and B. S. Connelly. 2008. “High Stakes Testing in Higher Education and Employment: Appraising the Evidence for Validity and Fairness.” American Psychologist 63 (4): 215–227.

Shultz, M. M., and S. Zedeck. 2011. “Predicting Lawyer Effectiveness: Broadening the Basis for Law School Admissions Decisions.” Law & Social Inquiry 36 (3): 620–661.

Thurlow, D. 2011. “Moving Forward on Premedical Education: Undergraduate Prerequisite Courses and Competency-Based Curricula.” The Advisor 31 (2): 11–18.


Richard W. Valachovic is the executive director of the American Dental Education Association.

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