On changes to the MCAT and on what makes a good doctor good

On Friday, one of the headlines in The Chronicle of Higher Education caught my eye: “Medical-Admissions Test to Look More Broadly at Who Will Be a Good Doctor.” The article states that, as of 2015, the MCAT, the nation-wide exam that is administered to students who hope to attend medical school, will be making some significant changes to its format. The writing sample, long the bane of science students but for me one of its most demanding and revealing sections, will be removed, a new section on explanations of human behavior will be added, and a new critical reasoning section will replace the old verbal reasoning section. According to the AAMC, “The new exam is designed to help prepare tomorrow’s doctors for the challenges, advancements, and reformations of our future health care system.” It seems the AAMC is seeking to strike a greater balance between scientific competency and humanistic care, with more weight now falling on the latter.

As someone who spent nearly a decade helping prepare pre-med students to take the MCAT, I have my doubts that the new test will be demonstrably better than the old one. During my tenure as a tutor, I met young kids, seeming adolescents, who had read nothing outside their discipline and knew very little in general; who, for 18 years, had been trained to take standardized tests and had become adepts at that; and who were generally kind, came from well-to-do families, and were more or less harmless. I admit; I liked them. Unlike GMAT or LSAT students, they usually thanked me and were mostly courteous, occasionally apologetic. They answered emails promptly and caught a few of my references and jokes. They could laugh so long as you tossed them a juicy softball. And their parents paid me without meddling or niggling or interfering and, compared with the parents of high school kids, kept themselves well off-stage. No drama, thankfully.

On the East Coast, tutoring is as commonplace as cell phones, both being monthly expenses built into the well-to-do’s family budget. Most students, if not all, were used to having tutors for most, if not all, of their educational lives. (“Mom, I can’t right now, I’m Skyping with my tutor.”) I wouldn’t say that any of them had really lived or felt or suffered greatly. Death, hard times, and setbacks were concepts, mere abstractions, classroom ideas like social justice and Africa. No, I would say that they were… nice, almost to a fault, as if life, having been frictionless so far, would remain frictionless to the end. Having been swept along for 21 years, having some idea that medicine was one of the few remaining noble professions, and having worked assiduously on touching anecdotes with which their personal statements were to win hearts and influence committees, they would expect that hard work would pay off for them again and that, all things considered, helping the unhealthy wasn’t such a bad way to spend a life. Besides, there would be plenty of interesting cases.

Hard work was what they lived by, hard work and a deep trust that a decent life lay quietly before them. While others partied, they studied; while others played it safe, they went all in. And yet if there were only one problem with this picture, it would have to be that hard work, helpfulness, scientific competence, test-taking prowess, and being generally decent are neither necessary nor sufficient conditions for being a good doctor. If the MCAT has never been a good measure of a student’s readiness for med school, then revamping the MCAT is unlikely to plug the hole.

It could be asked what makes a good doctor good. This is a matter I’ve discussed with my medical doctor friends on more than a few occasions, the latest occurring over email this past weekend. Below, I’ve clipped a part of that conversation out of a longer exchange I had with one estimable doctor friend. In my reply, I second his praise of Yale Medical School as being good preparation for residency.

Dear Anton,

I think we two believe in apprenticeship. That is what I take from your Yale example. The rest of it–the labs, the grades, the recommendations–is but guesswork. Show me how he talks to patients. Let me see his hands and eyes. Ask her whether she has read Chekhov.

I am reading Chekhov’s My Life, the excellent translation by Pevear and Volokhonsky. The prose is lovely but the existence is heavy. (‘Twas ever thus with Chekhov…) I think when you and I first met a year ago the “struggle for existence” was very much with me. Now, I struggle rarely and think the “struggle for existence” should be reserved, for those of us fortunate enough to be living in the developed world, only for those times when we’re muddled and trying to slog through. If our lives are to go well, however, they must be made graceful and just; we must make them so. I can’t say the same of those living in the developing world. For them, it’s doubtless a veil of tears, and Chekhov their earnest muse.

Good students should know about the veil of tears. Good doctors should attest to it. Good persons should know and have experienced both struggle and grace, should have made both their own.