Medical College Admission Test

In the 1920s, dropout rates in US medical schools soared from 5% to 50%,[11] leading to the development of a test that would measure readiness for medical school. Physician F. A. Moss and his colleagues developed the "Scholastic Aptitude Test for Medical Students" consisting of true-false and multiple choice questions divided into six to eight subtests. Topics tested included visual memory, memory for content, scientific vocabulary, scientific definitions, understanding of printed material, premedical information, and logical reasoning. The score scale varied from different test forms. Though it had been criticized at the time for testing only memorization ability and thus only readiness for the first two years of medical school, later scholars denied this. In addition to stricter medical school admission procedures and higher educational standards, the national dropout rate among freshman medical students decreased from 20% in 1925–1930 to 7% in 1946.

Advancements in test measurement technology, including machine scoring of tests, and changed views regarding test scores and medical school readiness reflected the evolution of the test in this period. The test underwent three major changes. It now had only four sub tests, including verbal ability, quantitative ability, science achievement, and understanding modern society. Questions were all in multiple-choice format. Each subtest was given a single score, and the total score was derived from the sum of the scores from the subtests. The total score ranged from 200 to 800. The individual scores helped medical school admission committees to differentiate the individual abilities among their candidates. Admission committees, however, did not consider the "understanding modern society" section to be of great importance, even though it was created to reward those with broad liberal arts skills, which included knowledge of history, government, economics, and sociology. Committees placed greater emphasis on scores on the scientific achievement section as it was a better predictor of performance in medical school.

From 1946 to 1948, the test was called the "Professional School Aptitude Test" before finally changing its name to the "Medical College Admission Test" when the developer of the test, the Graduate Record Office (under contract with the AAMC) merged with the newly formed Educational Testing Service (ETS). In 1960, the AAMC transferred its contract over to The Psychological Corporation, which was then in charge of maintaining and developing the test.

From 1962 to 1977, the MCAT retained much of its previous format, though the "understanding modern society" section was renamed as "general information" due to its expanded content. Handbooks at the time criticized the test as only a measure of intellectual achievement and not of personal characteristics expected of physicians. Admission committees responded to this criticism by measuring personal characteristics among their applicants with various approaches.

During phase four, the MCAT underwent several changes. The "general information" section was eliminated and a broader range of knowledge was tested. At this point, topics tested included scientific knowledge, science problems, reading skills analysis, and quantitative skills analysis. Individual scores were reported for biology, chemistry, and physics rather than a composite science score, thus six different scores for the whole test were reported. The score scale changed to 1–15 as opposed to 200–800 from previous versions of the test. Cultural and social bias was minimized. Though the AAMC claimed the new version intended to evaluate "information gathering and analysis, discerning and formulating relationships, and other problem-solving skills," no research supported this claim.

In 1991, the test changed again. Though the test was still divided into four subtests, they were renamed as the verbal reasoning, biological sciences, physical sciences, and writing sample sections. Questions retained the multiple-choice format, though the majority of the questions were divided into passage sets. Passage-based questions were implemented to evaluate "text comprehension, data analysis, ability to evaluate an argument, or apply knowledge from the passage to other contexts." A new scoring scale was also implemented. The total composite score, which ranges from 3–45, is based on the individual scores of the verbal reasoning, biological sciences, and physical sciences, which each have a score range of 1–15. The writing sample, which consists of two essays to be written within 30 minutes for each, is graded on a letter scale from J-T with T being the highest attainable score.

On July 18, 2005, the AAMC announced that it would offer the paper-and-pencil version of the MCAT only through August 2006. A subset of testing sites offered a computer-based version of the full-length exam throughout 2005 and 2006. A shorter, computer-based version of the test debuted in January 2007. The exam was at that point offered numerous times annually, and scored more quickly.[12][13]

Although many medical schools will not accept MCAT exam scores after three years, this version of the MCAT will continue to be reported by the AAMC until the 2019 AMCAS application cycle.[14]

The MR5 advisory committee was appointed by AAMC in fall 2008 to conduct the fifth comprehensive review of the MCAT exam and to recommend changes for the new exam set to be released in 2015.[15] The advisory committee had 21 members including medical school deans and administrators, basic and clinical science faculty, pre-health advisors, one medical student and a medical resident.[15] The recommendations determined were also based on responses from 2,700 surveys, over 75 meetings and conferences, and 90 outreach events to solicit input.[16] The recommendations considered the content and format of the MCAT, the resources that should be provided relating to the exam, and the changes that should be made to medical school admissions in general.[15]

Ratings of the Importance of Natural and Behavioral Sciences Topics for Mastery of Future Medical School Curricula[17]

To determine the content that should be tested for the exam, the MR5 committee surveyed medical school faculty, residents, and medical students, and asked what concepts entering students need to know to be successful in current and future medical school curricula.[18] Three separate surveys were sent asking about concepts in the natural sciences, research methods, and behavioral sciences. The MR5 committee also consulted various expert committees from within and beyond the AAMC.

The largest changes in the exam consist of testing in biochemistry, psychology and sociology concepts. The addition of biochemistry material follows survey results placing biochemistry concepts as highest importance for success in future medical school curricula.[17] The addition of behavioral and cultural material was recommended to provide a solid foundation for learning of these concepts in medical school. According to the committee, psychological science should be understood by medical students as an essential aspect of healthcare.[19] The writing sample section was also removed, since data showed that these scores were not used by most admission committees.[15] These changes were revealed in 2012 so that undergraduate premedical advisers studied the MR5 documents to translate tested core competencies into premedical course recommendations at their campuses.[15]

This version of the MCAT has been administered since March 2015, and is expected to be in place until 2030.[20]

This section tests chemistry and physics in the scope of biological systems, requiring understanding of organic and inorganic chemistry and physics as well as biology and biochemistry. Specifically, this section focuses on the physical principles underlying biological processes and chemical interactions that form the basis of a broader understanding of living systems. Understanding of research methods and statistics are also important to successfully reason through this material.[26]

The CARS section is similar to verbal reasoning sections providing passages with questions testing reading comprehension. The 500-600 word passages can cover topics ranging from the social sciences to the humanities, sometimes presenting in a convoluted or biased manner requiring the reader to consider what is being written from multiple perspectives.[25] The passages are designed to discuss topics that are unfamiliar to the reader, but success in this section requires strictly using information from the passage without using previously known knowledge.[27]

This section mainly tests biology and biochemistry but also requires an understanding of organic and inorganic chemistry. Students will have to answer questions about the functions of biomolecules, processes unique to living organisms, and the organization of biological systems. Understanding of research methods and statistics are also important to successfully reason through this material.[26]

This section tests psychology and sociology so that students can demonstrate their understanding of the behavioral and sociocultural determinants of health. Specific material tested include behavior and behavior change, perceptions of self and others, cultural and social differences that influence well-being and social stratification. Understanding of research methods and statistics are also important to successfully reason through this material.[26]

In the new MCAT exam, changes have been made not only in the content of the exam, but also in the way in which content is presented on the exam. MCAT questions will require examinees to demonstrate four Scientific Inquiry and Reasoning Skills that have been identified by the MR5 as crucial to success in science and medicine. The first skill is Knowledge of Scientific Concepts and Principles, which requires students to not only recognize and recall scientific information, but also to identify relationships between similar concepts. Scientific Reasoning and Problem Solving tests the student's ability to relate scientific theories and formulas to presented information to explain findings and draw conclusions. Reasoning about the Design and Execution of Research requires examinees to show that they can understand science in the context of experiments. The fourth skill of Data-based and Statistical Reasoning requires students to be able to read graphs and tables and draw conclusion from evidence.[26]

The following are the scores along with their percentiles from test takers from May 1, 2022, through April 30, 2023. MCAT percentiles are updated every year on May 1. The average scaled score was 501.6 with a standard deviation of 10.8.[30]