This was the beginning of a long and beautiful relationship with HEALTH PROF for Robert C. Bowman. If Marliss had not posted this, we would have missed out on many mutual learning experiences:
Friends,
We have lost our way. The good doctor Bowman asked advisors some days ago
to raise as a discussion piece how we might improve the selection process
for medical school to discover (or is it uncover) those humanitarian traits
that make for a good physician rather than relying too strongly on the best
and brightest as revealed through MCAT scores. The discussion that has
dominated this forum has been devoted to our various paper trails,
especially those dedicated to letters and the VMCAS service. As the
discussion proceeded, I expected to be enlightened on whether the evaluations
should be on white or recycled paper? or if red ink signatures carried more
weight than green?
This is silly and someone is paying. Yes, there are economies of scale,
but there is no economy in silliness.
Marliss Strange
University of Oregon
Dear Colleagues:
Marliss Strange makes a good point ("Byantium Lives Again"). What can we
say about the crux of the issue? How can health professional schools
identify the applicants who will become the best practitioners (best in a
wholistic sense)? That's a tough challenge for the admissions officers of
the professional schools. It's a tough challenge for us advisors trying to
both 1) help our students develop to their maximum potentials, and 2)
eventually provide meaningful evaluations of those students when they apply
for admission to professional schools.
Obviously I don't have the answers. But, today I was visited by a former
student who was a classic case: great grades, great science MCAT scores,
wonderful humanitarian instincts and experience, but no chance at
US/Canadian medical schools because of very low verbal reasoning MCAT
scores (repeated attempts). Why the low VR scores? I'm convinced it's
because English is not this individual's first language (I've seen it again
and again with such students). Fortunately, St. George's in Grenada took a
chance with this individual, who is performing near the top of the class
there.
I'll bet this student does fine on the USMLE. In the old days when MCAT
scores didn't have to be so high (and when there wasn't a verbal reasoning
section that, unintentionally I'm sure, appears to reward those most
familiar with the majority culture in the U.S.), students like this one got
into medical school in the U.S., and the ones I know ended up doing well on
the boards exams.
How many MCAT-challenged persons, who would be better physicians than some
of their colleagues accepted into medical schools, are never going to get a
chance?
And yet, I would hate to be a medical school admissions officer having to
justify denying admission to high-MCAT applicants in order to make room for
lower-MCAT applicants on the basis of subjective, non-quantitative
criteria.
Can we as advisors help out these admissions officers? How?
Charles (Chuck) F. Austerberry, Ph.D.
Assistant Professor of Biology and Coordinator of Pre-Health Advising
Creighton University, Omaha, NE 68178
Phone: 402-280-2154 (Office, RS 508) and -2321 (Lab, RS 514)
Fax: 402-280-5595
e-mail: cfauster@creighton.edu
Our educational enterprise has been and continues to be driven by very
traditional career advising which begins to track students based on qualifiable
cognitive criteria soon after education moves from the experiential and concrete
teaching methods in the primary grades. Mathematics and Science education are
taught in a vacuum and as the ends rather than the means. The highly acclaimed
NCTM standards gave me a bit of hope when, in somewhat of a footnote and
afterthought, the standards suggested that mathematics instruction should be
based on real-life experiences and be culturally competent. Unfortunately, the
standards became a call to arms for science, geography, economics, political
science/government, language arts and the humanities educators whose battle
cries challenge us to embrace their specific discipline to arrest the downfall
of our educational standards.
Is it possible that we may be able to define education as a tool to promote the
national welfare, as conceived by the "founding fathers" when they crafted the
constitution? Can we look at RAW knowledge, reading arithmetic and writing,
(better known as the 3 R's in academia) as the tools to quantify, qualify and
communicate the world we live in; integrate these with the humanities and
behavioral sciences to appreciate the interdependence of the physical, social
and psycho-social systems?
I began to struggle with these issues a few years back when I began to teach a
diversity seminar for medical students and got the feeling that what we were
attempting to do was too-little too-late especially if the theories of
cognitive, human growth and moral development, as presently outlined in the
literature hold true. I continue to teach this seminars for our family medicine
residents within the behavioral medicine rotation and get a great deal of
satisfaction when the residents articulate caring, nurturing and other signs of
compassion.
My comments may off-track, but I hope that we can continue this discussion.
Best of luck.
==============
Alfonso López-V.
OHSU-Multicultural Affairs Office
(503)494-7574
Mail Code L601
lopezvas@ohsu.edu
I'd like to comment on this discussion from the MCAT
perspective.
I believe that most medical schools are in consonance with
the philosophy underlying most of the listserv's discussion on
this topic. The guidance and direction we at AAMC received
from the medical school deans when we began developing a
new MCAT test at the end of the 1980s lead us to design the
test to reinforce the goal of identifying medical school candidates
who are educated in the social sciences and humanities as well
as in the natural and physical sciences.
Consider the fact that half of the test's four sections are not
based upon science knowledge - 50% of the MCAT score
(the Verbal Reasoning score and the Writing Sample essays score)
access non-science related reasoning and communicative skills.
In addition, the structure of the new MCAT's science questions,
which are based mostly on passages or experiments, access
scientific reasoning processes and the ability to interpret and apply
varying data, rather than science facts and formulae. This may be
a partial explanation for an interesting MCAT statistic: that
examinees who self-describe their major as Humanities consistently
have higher mean scores on the Physical Sciences and Biological
Sciences sections of the test then do those who indicate their major
as Biological Sciences. Granted, the number of humanities majors
taking the test is relatively small, but our test design was intended
to encourage interest in medicine by such students.
Jack Hackett
MCAT Section, AAMC
jhackett@aamc.org
1/26/2000 Health Prof
When I was a member of a college health advisor list serve, I asked the group a question about selection vs socialization. Initially there was no response, then a regular member of the group chastised the others and several chimed in.
It was interesting to find out how far back candidates were selected
and shaped for admission. Every advisor wanted to tell the parents of
bright young high school students that their college had a 90% or greater
record of getting students into professional school. Of course there was
always some attrition along the way, sometimes shaped by the advisors
themselves by overt activity or lack of encouragement. The overt activity
for the candidates known to be desired by the medical school was easy. The
failure to encourage the borderline candidates, even those "felt" to
possess the "stuff that doctors really need to have", was difficult. Some
denied that this went on but others felt that they did so to prevent
setting students up for false hopes, and then of course their admission
percentage was at stake.....
The rest of this is from the rural family medicine web site at Selection vs Socialization
More there if you want to read more detailed info:
Further listserve deliberations centered on the issue of whether
medical students were either selected for the wrong characteristics or
whether they were socialized into non-caring roles (as per anthropologist
Melvin Konner and others). Frankly, I think it is a little of both.
Experienced faculty lament those lost to medical school socialization. On
the other hand, even the most cavalier students seem to fall in step when
our small group M2 discussion involves them in a personal fashion. Poverty
and medicine gets some polite, but brief attention when presented in
didactics and brief discussion, but students shine when they debate the
ethics of our medical education system in which the least-trained practice
their skills on the poor or disadvantaged - those with little on no ability
to complain.
It is also easier to do quantitative presentations than qualitative experiences. It took me two years and 10 presentations to get superior evaluations from students when I talked about teenage pregnancy. It took me two months and two talks to get there when teaching the same students about electrocardiograms. Good educational experiences often take time and multiple resources.
When Bob Boyer, a rural FP from Kingman, Kansas, tells his stories about rural practice at the national meeting of family practice residents and students, Blizzard we always have a few of the residents comment about how they have been recharged and refreshed. They note that their faith in their primary reasons for becoming doctors has been restored. Boyer Links and Presentations
To me these are all
signs that medical education has a negative socialization effect. School
missions, attitudes, curricula, and reward systems all influence students
along with selections. If the same students can respond, even at senior
levels, there is a reason for change.
Can We Modify the Socialization Process?
Having taught at some of the newer medical schools, there is a
different attitude and mission that does seem to influence students. There
are different relationships between faculty and departments and students.
Students there are more open to cultural, interdisciplinary, public health,
primary care, and rural items. Obviously we cannot continue to build more
medical schools, but we can reconstruct the medical education process. It
is unlikely that we can modify the major medical centers, but we can move
students out of these areas for training. Many are overcrowded and give
students a passive style of training that is poorly suited to rural
practice where decisions have to be made more independently and where more
procedures are done.
At medical centers, rural student interest groups can band students together to resist urban and specialty pressures. Rural rotations, particularly the longer ones such as RPAP in Minnesota, can get students away for some time. Rural campuses for the first or last two years can also be a help. Basic science faculty could also be rewarded more for teaching, especially if this involved developing web-based teaching modules so that students did not have to live in urban areas.
Faculty need to be made aware of rural needs through focus groups and visiting rural practices. Academic medical centers could contract with rural networks for specialty care to preserve or increase their patient base, rather than ignoring rural practitioners and giving them little or no information about patients when they come to the centers for care. Medical schools should improve efforts in doctor-patient communications, community-based care, and physician leadership skills so that those considering rural practice can build the skills and confidence needed for a rural practice choice.
For the most disadvantaged populations, medical schools will need a
different type of preparation. Natives and many Asian populations have a
great need for physicians to be able to deal with the spiritual aspect of
health. Why should a native go to college, medical school, and residency to
become a second class healer, one who cannot deal with spiritual issues?
Also the urbanization that occurs would inhibit a return to the reservation
or underserved population in need. Admitting urbanized natives or other
minorities is less likely to meet the needs of the truly underserved.
There are still major barriers with admission committees. Few have
significant training. With busy schedules in many other areas, few have
time or motivation to take up the challenge of shaping the next generation
of physicians. Rabinowitz has demonstrated that a small program with 1% of
Pennsylvania's medical school graduates can produce 21% of the state's
rural family physicians
Rabinowitz Howard
Selecting for rural and true family practice interest can help with
retention. Few also help the "right" candidates improve their chances of
admission, even though rural and minority studies show that this is
possible and desirable. Nearly every medical school has a program to
enhance their minority admissions. Studies at UTMB Galveston note that
minority applications and admissions can continue or increase with these
programs despite the reversals of affirmative action. There is reason to
believe that more and better rural candidates can enter, especially rural
candidates who are also a member of an underserved minority.
More at the web site above, also more about State Educational policies
shaping admissions at the same web site -
Centralization and Regionalization
Note that these are not peer reviewed yet, your comments would be
appreciated.
......That being the case,
it becomes the task of the Admissions Committee rather than the Curriculum
Committee
to produce well-rounded physicians. Taking it a step further, it is a
function of
the mission statement of the institution to determine the underlying
philosophy of
the education it provides..... David R. Little, MD MS
All college students with interest in the health professions (special track
or not) face accelerated schedules dating back into the high school years,
through the college advisors, and on to the admissions committee. The
admissions committee shapes the preparation by setting prerequisites. The
school pressures the admissions committee to make accreditation as easy and
certain as possible, also jobs easier for faculty. I am amazed that there
are any with the right characteristics remaining. Perhaps the situation is
so bad as to precipitate the realization that there must be a better way.
Perhaps it is easier to make mistakes by choosing earlier rather than after
an established intellectual record!
Second, the situation delays maturation with consequences apparent to most
medical families and marriages.
Third, it really does not seem to matter where and how the students are
educated. They seem to do well despite the location, method, or emphasis of
the current day/whim of medical leaders/funding agencies/etc.
If we really do believe that we can educate medical students, then we can
afford to take a little more academic risk on some with more service and
communications skills and a bit less academic prowess. The question
remains, why don't we force better choices? This would of course require
more teaching effort and more funding, but we might just restore some faith
in medicine over a couple of generations.
Why not 2 or 3 smaller med school classes admitted during a year? It would
make it less risky to do more work with students who need extra help in a
certain area with only a few months delay. It would encourage students to
take a segment off for re-evaluation or special interest or broadening or
family needs. It would prioritize teaching since a few could then be
encouraged to teach full time instead of once a year.
Dear Bob: I sit on the Admissions Executive Committee for the University
of Washington. The committee has a strong representation of Family
Practice and Primary care. We are quite proactive in admitting
candidates from rural backgrounds-- We too are very concerned about the
decline in our graduates' interest in family practice in particular and
primary care in general.
We think that there may be proportionately fewer applicants from rural
backgrounds and plan to study this more closely. We think that it may be
necessary to enrich the 'pipeline' and that we may need a proactive
program to help rural applicants present competitive application packages
similar to the MMEP program. I would be very interested in working with
you on this topic. Ron
Ronald Schneeweiss MBChB
Department of Family Medicine
University of Washington Box 354696
Seattle WA 98195
sron@u.washington.edu
Phone (206)-685-0401
FAX (206)-685-0610
Education - the entire pipeline