Aug 22 2008
The pertinent literature makes it clear the MCAT is pretty good at predicting early medical school success, only fair to poor at predicting late medical school success and virtually worthless in predicting success as a physician (Evolution of the MCAT, Validity of MCAT).
Beginning in the late 1940’s an extensive effort was undertaken to try to classify education goals and objectives and how learning occurs. This effort resulted in three domains (or see domain details) of how students learn. How do these relate to the MCAT and the prediction of who will become a successful physician?
Now, lets focus on the Psychomotor Domain.
The Psychomotor Domain involves the physical or kinesthetic component of learning. This domain includes physical movements, coordination of movements, and use of the motor-skill areas. This domain is only achieved through practice and is measured by parameters such as speed, precision, distance, procedures, or techniques in execution. Simpson proposed seven dimensions from the simple to the complex as:
1. Perception (The use of sensations to determine actions. Begins with sensory stimulation, to selection of specific cues, to the translation of these stimuli);
2. Set (Readiness to act mentally, physically, and emotionally. These predetermine a person’s response to situations (or mindsets));
3. Guided Response(Earliest stage of trial and error learning. Only practice results in proficiency);
4. Mechanism(Intermediate stage of motor actions becoming habitual with increasing confidence of performance);
5. Complex Overt Response(The final stage of most proficient performance indicated by quickness, accuracy, high coordination of performance, with minimum of effort/energy and with automaticity.);
6. Adaptation (Skills are well developed and the individual can modify movement patterns to adapt to special situations/circumstances);
7. Origination (New movement patterns are created to fit special situations/circumstances.)
(Reference: Simpson E.J.(1972). The Classification of
Educational Objectives in the Psychomotor Domain. Washington, DC: Gryphon House.)
How do the learning domains relate to success as a physician and the role of the MCAT? See: MCAT Validity in Perspective
Refer To: Why MCAT Fails to Predict Physician Success, MCAT and Cognitive Domain, MCAT and Affective Domain
Aug 21 2008
Careful review of the structure and question types on the MCAT as found in the MCAT Student Manual demonstrate they correlate closely with the Cognitive Domain dimensions of Bloom. These are also the dimensions important for the first two years of medical school and for the USMLE’s. It then makes sense that the MCAT is a great predictor of the first two years of medical school and the USMLE I (or really any standardized test). So, the MCAT’s strength is in predicting the cognitive domain…but, is this enough to predict physician success?
I do not believe it is. A good physician is much more than the cognitive domain. If the job of the physician is to diagnose and heal, certainly a level of knowledge is essential, but, it is not sufficient. An appreciation of the other learning domains make this clear.
The description of the Affective Domain reads like the characteristics of an ideal and effective physician. We might simply call it “bedside manner”. It is this aspect of learning which begins during the second two years of medical school, the clerkships, and continues for the lifetime of the physician. Yet, it is not measured prior to admission. For a physician, all physicians, it is as important as the Cognitive Domain. The Affective Domain is probably one of the reasons why certain students seem to bloom during the clerkship years who may have some difficulty during the first two years. The combination of the Cognitive Domain and the Affective Domain is critical to all physicians and especially to primary care physicians. The ability of a student to learn and apply themselves in the Affective Domain will make him/her a more effective and successful physician. But, the MCAT does not measure this domain at present.
Finally, the Psychomotor Domain is critical to physicians who rely on motor skills and abilities. This will include the surgeons, specialists, such as interventional cardiologists, and many others. Again, the MCAT does not measure the ability of a potential physician in this domain. How many great surgeons have been bypassed, who had great psychomotor ability, because it was never assessed?
In summary, the MCAT is good at what it does, measurement of aspects of the Cognitive Domain, but, the total physician requires significant contributions from the Affective Domain and the Psychomotor Domain which are not measured. This is good reason for legitmate admission considerations beyond just the MCAT or GPA.
Refer To: Why MCAT Fails to Predict Physician Success, MCAT and Cognitive Domain, MCAT and Affective Domain, MCAT and Psychomotor Domain