So I was talking to a friend of mine the other day; who took the MCAT, USMLE, etc. and is now a practicing EM physician.
And he mentioned about a particular “third tier” thinking that was involved in these types of exams. Can anyone tell me how this third level (third tier) thinking translates to success as a medical student?
I’m curious to know because recently within my circle of friends it has been stated that a good MCAT score does NOT necessarily translate to a good practicing physician. It only translates to a probable higher likelihood that the student will indeed succeed in their medical school studies.
But if the MCAT gauges the test taker’s ability to think (or problem solve) at a higher degree or “tier” and it is that type of thinking that makes a successful student then does it not follow that it would also translate to a good knowledgeable physician???
This is what I’m confused about. I’m sure that this type of discussion is not new and that there are some of you that have had this particular conversation with the people you know…
So can anyone help shed some light on this subject???
I don’t have any info about the MCAT specifically, but I’m reading an absolutely fascinating book right now - Outliers by Malcolm Gladwell. In one part of the book, he discusses IQ and college entrance exams, etc. What his investigation has shown is that there is a certain threshold for intelligence. For example, there is surely a noticeable difference in intelligence between someone with an IQ of 100 and someone with an IQ of 120; however, someone with an IQ of 180 is no smarter than someone with an IQ of 120. There is a certain threshold, beyond which it really doesn’t matter how many additional IQ points a person has. The next “level” of intelligence he discusses is practical intelligence which includes things like knowing what to say and how to say it - things involved in navigating through the world around you, things not tested by basic IQ tests. He then says that a person MAY be successful if they have IQ intelligence, or they MAY be successful if they have practical intelligence, but they will LIKELY be successful if they have both.
In my opinion, this theory applies to the MCAT. Beyond a certain threshold, it really doesn’t matter what the score is. I find it hard to believe that a person scoring in the 40’s will be any better physician than someone scoring in the 30’s. The MCAT only tests one level of knowledge - how that knowledge is applied in real-life situations is an entirely different story. Beyond a certain minimum threshold, it just doesn’t matter - in my opinion 
Incidentally, this is an enlightening book to read if you’ve ever wondered why your family prevented you from doing the things you wanted to do with your life, or why they didn’t encourage your curiosity or interests.
Reading your post, I remembered one of my favorite exchange in House MD (although unrelated, but too good not to share).
Dr Kuty (talking to House about a problem) “I am sure you will figure it out; between you two, your IQ is 300”
House’s reply “That’s also True of 5 morons”.
Just excellent. Again, my apologies as it may be unrelated. I just love the quote.
Back to MCAT threshold, I know that some school extend automatic interview past thresholds of GPA and MCAT. At least it is rumored for my top school (UTSW) and if I remember and based on my readings on SDN, it would be 3.7 and 32 MCAT (AND TEXAN). Just a rumor though.
My understanding of the MCAT is that is a reliable predictor of an applicant’s ability to perform/succeed in medical school. As it stands it doesn’t really address other things, which is presumably what all of the clinical experience, shadowing, volunteer work, and interviews are for.
I read an article a year or two ago about how some medical schools are starting to shift to multiple mini interviews (or MMI’s) because an applicant’s academic capabilities don’t necessarily translate into being a good doctor as you’ve mentioned, and they wanted to test one’s affinity for social interactions more. That might also have something to do with the rather sweeping changes that are being made to the exam for 2015.
A good physician requires those problem solving skills, it is true. But, a good physician must also have people skills and be a good communicator. They must also pick up on nonverbal cues and other things. The MCAT doesn’t do much to screen for those abilities.
Just my two cents.
What I got from the MCAT prep/test was the necessity to apply what you know with situations that you probably haven’t seen before. “Critical thinking” if you will. A lot of the questions are simple topics phrased in a way that makes you go “what is this actually saying.” It also tests your ability to link multiple subject areas to come up with either the right methodology to calculate the answer or to follow the right knowledge pathway to reach the answer. It is by no means a “regurgitate what you studied in class” test.
I can only imagine that this is the type of thinking that goes into coming up with differentials and diagnoses. You know what you know, but you have to apply what you know/reason through what you don’t know to how the patient presents.
Knowledge alone does not make a good physician. The ability to apply that knowledge with compassion and tact goes much further than acing the Steps. It’s equivalent to EQ being a better indicator of success than IQ. The same goes for physicians, simply because they’ve done outstanding on their exams does not translate that they will be outstanding with patients or even in the practice of medicine. As in “tons of book smarts but zero common sense.” You’ll run into plenty of gunners who will not get residencies for the same reason that med school applicants with 4.0/45 do not get accepted…the interview is the great equalizer. The other thing is unless these “genius’” have had some tempering socially they behave as though they are entitled to be heralded as demigods because of their scores…so they are shunned during residency…and things only get worse.
As an example I worked with an ATTENDING who carried a copy of his MCAT & Step results in his wallet… When he showed them to me he had been practicing for about 5 years so at that point he’d been carrying the results for 10-15 years… How well do you think he was with patients? How well do you think he was with his colleagues? He is who House, M.D. is modeled after. You go to him when you can’t figure something out but never to see your patient nor be treated as an equal.
Julio Cesar - I have worked side by side with physicians for years. Some are brilliant, talented, geniuses, and compassionate clinicians. Some can barely find their way out of a paper bag. So sorry, but true. Met a doctor, practicing in a PRISON, who had NO functional knowledge of addictions. The inmates played him like a violin, and unwittingly, he was supplying the drug trade in the prison yard. Met another, who diagnosed ALL his psych patients with the SAME diagnoses, and was only willing to prescribe ONE medicine. He took severely psychotic individuals off their medications, resulting in hospitalizations…and was condescending and MEAN to the patients. If a patient had insight, and disagreed with the diagnosis, he would become angry, and sometimes psych arrest them. He was an bitter, miserable man, and I later found out, was not accepted to anesthesiology residency and begrudgingly accepted psychiatry. As a patient myself, I have been poorly treated by some, misdiagnosed by others, and only through perseverance and my OWN medical knowledge, finally received the correct treatments. Several of MY patients were, bluntly, nightmares of medical mismanagement who ended up with conditions that changed their lives forever based on poor care. Just because someone passes the MCAT and is a brillant scientist and good at the Rubics cube of scientific reasoning, DOES not translate into a competent, well versed, compassionate doctor. Just my 2 cents and part of my motivation to become one!
One thing that I hear from the school I’m interested in is that they see the MCAT as a good predictor for the USMLE STEP 1.
Check out page 14 of this document. It’s some detailed stats about an old class at UAMS. You can see from this data that those with higher average MCAT score had a higher pass rate on Step 1.
I don’t know that you can draw any real solid conclusions from the data, but I think doing well on the MCAT sets you up for a) being a good test taker, and b) being able to consolidate a large body of knowledge and accessing it in order to solve problems.
Having taken all the exams - the MCAT does not involve thinking in multiple steps.
For those that don’t understand the thinking in multiple steps or levels - you can listen to an interview I did with Dr. McInnis - http://www.medicalschoolhq.net/28.
Basically, the question body asks the question so that you first have to know what the diagnosis is, then second have to know what the first line treatment is, THEN they ask you a question. So you have to know multiple answers, to get one question right. AWESOME.
The MCAT is a test of comprehension and application that allows adcoms to compare GPAs of applicants against something. Two students with 3.9’s from very different schools are not equal if one has a 35 and one has a 27. Yes - academic achievement (GPA and MCAT) have been shown to be predictive of MEDICAL SCHOOL success - this has NOTHING to do with success or aptitude as a physician.
I hope that helps!
Ryan