March MCAT Madness

Your MCAT score matters, but don't be intimidated.

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As primitive as it may seem to today's medical school applicants, until just a few years ago the Medical College Admission Test (MCAT) was administered by pencil and paper, and it was given just two mornings each year: once in April and once in August.

April was the more popular time to sit for the MCAT; not surprisingly, the March before the exam, a typical pre-med was busy with a lot more than ESPN and basketball pools. To applicants, the arrival of March meant that it was time to prepare for judgment day, when they confronted the potentially ugly reality that all those long days and sleepless nights spent in the cold, unloving company of the Krebs Cycle (or was it the Carnot Cycle?) were going to be crystallized in one epic 325-minute multiple-choice and essay-writing crusade.

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Wait, is it really that bad? Is the MCAT the integral component of what is likely to be the most important application you submit in your entire professional life? Or is it just another paper tiger (or computer based tiger?) in the seemingly endless army of standardized exams on the road to practicing medicine?

The reality, of course, lies somewhere in between. Almost all U.S. medical schools require the MCAT (One of the few exceptions was featured prominently last year in the New York Times.) A spectacularly poor showing certainly can sink an otherwise sparkling application. But on the flip side, the admissions committees do recognize that, for better or worse, your MCAT score represents only about 6 hours of your undergraduate performance; the rest of the application–GPA, CV, letters of recommendation, etc –represents the other 35,000 hours of your four-year undergraduate career.

When we frame it that way, you might wonder why admissions officers are so interested in MCAT scores anyway? Understanding the role of the MCAT will provide the answer.

Prior to the 1920's, when the MCAT was first introduced, the attrition rate from U.S. medical schools was as high as 50 percent, so the exam was developed as a means to "weed out" the matriculants destined to fail or drop out. By 1946, the attrition rate had fallen to 7 percent, and it currently sits at less than 1 percent. But the MCAT's role has evolved in two important ways.

First, because attrition is really not the issue anymore, it is clear that the MCAT's primary role is now to assist in student selection, helping distinguish the "shield-your-eyes brightest" from the "merely bright," and everyone in between. We all know that inter-collegiate variation in the grading curve and other university-specific factors will introduce significant inequality in most of the application (using a "college prestige correction factor" can never completely compensate for the inequity of these measures). Thus, the MCAT serves as the great equalizer to the admissions committee: whether you spend your 35,000 hours in Cambridge, Massachusetts, or Cambridge, Minnesota, during the six hours of the MCAT, all pre-meds are considered equal.

Second, many studies have demonstrated the MCAT to be an excellent predictor of future medical school performance in general, and USMLE Step exams in particular (especially Step 1).

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So here's our advice: take the MCAT, and take it seriously. If you've survived the bulk of your pre-med curriculum with a decent GPA, you can, and will, succeed, as long as you don't let the MCAT intimidate you. And it shouldn't.

Whether your personal approach is to take an MCAT prep course or to take a pre-MCAT beach vacation, above all, know thyself. The goal of your MCAT preparation should be to consolidate your knowledge and thereby gird yourself with the confidence you'll need to defeat the computer-based tiger.

Joshua U. Klein is a Board Certified OB/GYN and a Clinical and Research Fellow in Reproductive Endocrinology and Infertility at Columbia University Medical Center in New York City. After earning his medical degree at Harvard Medical School, he completed residency at Harvard's Brigham and Women's Hospital and Massachusetts General Hospital.